Maternity Information Booklet

Maternity Information
Booklet
Portiuncula University Hospital

Ballinasloe,
Co. Galway
Maternity Information Booklet
Welcome
Welcome to Portiuncula University Hospital and congratulations on your pregnancy!
While having a baby is one of the most exciting things that can happen to you, we
understand it can also be an anxious time. We hope that the information provided in
this booklet will help you make informed decisions about your care and the care of
your baby/s. Please do not hesitate do ask for more information or clarification from
our staff.
Our maternity unit was opened in 1943 by the Sisters of the Franciscan Missionaries
of the Divine Motherhood and is now part of the Saolta Hospital Group. The maternity
ward has 33 beds, a four bedded labour ward and an admission room. These together
with the Early Pregnancy/Assessment Unit are located on the second floor of the
hospital. The Special Care Baby Unit is situated on the first floor.
Acknowledgements
Portiuncula University Hospital would like to thank the many people who were
involved in contributing and reviewing the information provided in this booklet,
especially our General Manager, Director of Midwifery, Consultant Obstetrician,
Clinical Midwife Managers, Staff Midwives, Midwife Specialists (Lactation and
Neonatal Resuscitation), Physiotherapists, Dieticians and patient advocate.
Contents
Welcome
General Information 4
• Important contact numbers 4
• Visiting hours 4
• Protected mealtimes 4
Antenatal Care 5
• Your first antenatal visit 5
• Midwives clinic 5
• Antenatal screening checks and tests 5
• Ultrasound scan 8
• Non-Invasive Prenatal Testing 8
• Your baby’s movements in pregnancy 10
• Vaccines and pregnancy 13
Your Health in Pregnancy 15

• Healthy eating for pregnancy 15
• Food pyramid 16
• Vitamins and minerals 17
• Take care with some foods 19
• Exercise and pregnancy 21
• Pelvic floor exercises 24
• Posture 26
• Optimal Fetal Positioning 28
• Common pregnancy symptoms 30
Lifestyle advice 36
• Pregnancy & Alcohol 36
• Smoking in Pregnancy 37
• Medicines 37
• Drugs in Pregnancy 38
• Travel during Pregnancy 38
• Domestic Abuse 39 1
Infections in pregnancy 40
• Group B streptococcus 40
• Sepsis 44
• Cytomegalovirus (CMV) 45
• Hand Hygiene 46
Pregnancy Complications 47
• Pre-eclampsia 47
• Gestational Diabetes 49
• Deep Venous Thrombosis 52
Getting ready for birth 56

• Antenatal preparation classes 56
• Hypnobirthing-antenatal preparation classes 57
• Breastfeeding workshop 58
• Birth after caesarean 59
• Preferences for birth (back page of booklet) 112
• Packing your hospital bag 61
Labour and Birth 62

• Signs of labour 62
• Stages of labour 66
Pain relief in labour 69

• Continuous one-to-one support in labour 69
• Comfort measures 69
• Cognitive strategies and hypnosis 70
• Transcutaneous electrical nerve stimulation (TENS) 70
• Entonox 73
• Pethidine 74
• Epidural 74
Induction of Labour 77
• Membrane sweep 77
• Prostaglandin gel/pessary 78
• Artificial rupture of membranes 78
• Oxytocin 78
2 • Risks associated with induction 79
Special Care Baby Unit (SCBU) 80
After the birth of your baby 82

• Optimal cord clamping 82
• Skin to Skin contact 82
• Vitamin K 84
• Baby tagging system 83
• Midwife’s check 86
• Blood loss 87
• Breast changes 87
• Care of perineum 87
• Bowel motions 88
• Mobility 88
• Deep Vein Thrombosis (DVT) 89
• Cervical screening 89
• Breast self-check 90
• Postnatal exercise 91
• Family planning 93
Care following Caesarean Section 96

• Abdominal wound care 96
What to expect emotionally 98

• Baby blues 98
• Postnatal depression 98
• Perinatal support group 99
Caring for your baby 100

• Keeping your baby warm 100
• Feeding your baby 100
• Vitamin D 105
• Safe sleep 106
• Tummy time 107
• Screening tests for your baby 108
• Immunisations 110
Going home 111 3

General Information
Important Contact Numbers
Portiuncula Hospital (090) 9648200
Labour Ward (090) 9648250
Maternity Ward (090) 9648233
Outpatients Dept. (090) 9648372
Physiotherapy Dept. (090) 9648279
Social Work Dept. (090) 9648306
Accident & Emergency (090) 9648248
Visiting Hours
Portiuncula University Hospital is committed to providing a safe and secure
environment for all our families who use the service.
An’ Authorised Access’ approach is in operation on the second floor of the hospital. All
visitors who wish to gain access to the Maternity unit, Labour ward, Early Pregnancy
Assessment Unit and Private Consultant rooms will have to use the intercom system
to gain access. Ward entrance to Maternity unit shall remain closed outside of visiting
hours.
2.00pm-4.00pm
6.30pm- 8.30pm
Main entrance door of the hospital will be closed from 9pm to 7am, please use
Accident & Emergency department entrance during these hours. If possible telephone
the maternity unit in advance to let staff know of your impending arrival.
Protected Mealtimes
Portiuncula University Hospital has a Protected Mealtimes policy. This means that
during, breakfast from 8am to 8.30am, lunch from 12.45 to 1.30pm and tea time from
5pm to 5.30pm all non urgent activities on the ward will stop. We ask visitors to try to
avoid visiting or telephoning the ward during mealtimes unless absolutely necessary.
4 There are snacks available outside of these hours for pregnant and lactating mothers.
Antenatal Care
First Antenatal Booking Visit
Antenatal care is important to support a healthy pregnancy and to prepare you for the
birth of your baby by taking preventative steps to avoid or minimise problems.
Antenatal care begins from the moment you know you are pregnant. Once your
doctor confirms your pregnancy, he or she will discuss with you the arrangements
that need to be made for your antenatal care. It is usual to have shared care between
your doctor and the hospital antenatal clinic.
The midwife and doctor will talk to you about your medical, surgical, obstetric and
family history. Also, the doctor may carry out a physical examination, which includes
checking your heart and lungs. You really need to set aside a few hours for this visit so
that you can discuss all aspects of your pregnancy with the healthcare professionals.
Midwives Clinics
Following your initial hospital booking and early pregnancy dating scan, if you and your
pregnancy is assessed to be low/normal risk seeing a midwife at the midwifery clinics
will be considered the most appropriate pathway for your ongoing pregnancy. The
midwives in the clinic work with the support of multi-disciplinary teams. If a problem
arises at any stage during the pregnancy you will be referred to an obstetrician in the
hospital and the responsibility for ongoing treatment decisions will lie with you and
your obstetric team.
Antenatal screening checks and tests

Most pregnant women have between seven and ten antenatal appointments,
sometimes more if they need extra care and support. At each antenatal visit your
midwife will monitor your blood pressure, your baby’s growth, heart rate, baby’s
position, and check on the general health of both you and your baby. Midwives/
obstetricians will discuss available screening tests (blood tests and ultrasounds) with
you during your pregnancy, arranging these as required. Your midwife will provide lots
of information about labour, childbirth and looking after your newborn baby.
5
Blood Tests at Your First Antenatal Visit

With your written permission, several blood tests are taken. You will be happy to
know that all these tests are usually taken at the same time. These blood tests will:
• Check your haemoglobin level (iron)
Your haemoglobin level (iron) which is the iron containing oxygen in the red blood
cells. The baby will take as much of this iron as it needs from your body. This can
often leave the mother anaemic and feeling very tired with no energy. The aim is
to keep your haemoglobin level above 11. This test will be repeated at 28 weeks
gestation.
• Check your blood group.
There are four types of blood group - A, B, AB or O. For each of the blood groups,
there is Rhesus factor either positive or negative. The rhesus factor is very
important in pregnancy because a rhesus negative mother carrying a rhesus
positive baby could develop antibodies against the baby’s blood, causing anaemia
and jaundice in the baby. This test will be repeated at 28 weeks gestation.
• What does RhD negative mean?
The rhesus factor is found in the red blood cells. People who are rhesus positive
have a substance known as D antigen on the surface of their red blood cells - they
are said to be RhD positive. People who are rhesus negative do not have the D
antigen on their blood cells - they are RhD negative.
Whether a person is RhD positive or RhD negative is determined by their genes
that is, it is inherited from a parent.
• Why does RhD status matter?
RhD status matters if a woman who is RhD negative becomes pregnant with a
baby who is RhD positive. This can only happen if the baby’s father is RhD positive
but not all children who have an RhD-positive father will be RhD-positive, because
the father may have both RhD-positive and RhD-negative genes.
If any of the blood cells from a RhD-positive baby get into the blood of a RhD-
negative woman, she will react to the D antigen in the baby’s blood as though it is
a foreign substance and will produce antibodies.
This is not usually dangerous in a first pregnancy, but in later pregnancies the
antibodies in the mother’s blood can cross the placenta and attack the blood
cells of a RhD-positive unborn baby. This can cause ‘haemolytic disease of the
newborn, which is also known as HDN. HDN can be very mild and only detectable
by laboratory tests. But it can be more serious and cause the baby to be stillborn,
severely disabled or to die after birth as a result of anaemia (lack of iron in the
blood) and jaundice.
6
• Targeted anti-D Prophylaxis

Anti-D injections are only needed if an RhD negative woman is pregnant with
an RhD positive baby. In about one in three pregnancies, the baby will be Rh D
negative and the anti-D injection would be unnecessary. By identifying the unborn
baby’s blood group we can ensure that only women who need it will receive anti-D.
• Determining the unborn baby’s blood group
A small amount of the unborn baby’s DNA is present in the mother’s blood. By
isolating the baby’s DNA from the mother’s blood it is possible to determine the
unborn baby’s blood group. This is called the cell free fetal DNA (cffDNA) test.
The cell free fetal DNA (cffDNA) can be taken in Portiuncula University Hospital
and sent to a laboratory in Bristol for analysis’s from 11 weeks (11+3 days) of
pregnancy onwards. The result will be available within two weeks of the test being
performed.
To understand the implications of the results from your cffDNA test we recommend
discussing your results and treatment options with your midwife, doctor or other
lead clinician who is responsible for your care.
• Check your rubella immunity (German measles)
Women are routinely tested to find out if they have immunity to rubella. Most
women are immune to rubella due to the MMR vaccination they received as a
child. If the blood test shows that you are not immune, you will be advised how
best to avoid exposure to rubella during the pregnancy and you should get the
vaccine from your GP after your baby is born.
• Check your varicella immunity (chicken pox)
If you have been exposed to chickenpox and you have had chickenpox, you will be
immune and there is nothing to worry about. You do not need to do anything. If
you have never had chickenpox, or are not sure, see your GP as soon as possible.
You can have a blood test to find out if you are immune. 8 out of 10 women in this
situation will be immune without realising it. If you develop a rash in pregnancy,
you should contact your GP or midwife.
• Check for sexually transmitted infections
If your blood test is positive for syphilis, you will be offered treatment by means
of injections of penicillin. If left untreated, syphilis can lead to miscarriage and
stillbirth.
Hepatitis B can cause liver disease. If you are Hepatitis B positive, giving your
baby immunoglobulin treatment soon after birth and follow-up immunisation in
the months ahead can protect your baby.
All women are offered testing for HIV and, if you test positive, you will start on
antiretroviral treatment, which reduces the risk of transmitting HIV to your baby.
You will not receive notification if the blood tests are normal. The results will be
filed in your healthcare record for you to see at your next antenatal visit. 7
Ultrasound Scan
We offer all women an ultrasound scan early
in their pregnancy between 10-15weeks. This
scan is able to check your estimated due date,
the number of babies you are expecting and it
will show you the baby’s heart beating. You will
need to have a full bladder for any scan before 15
weeks. If there are concerns about your baby’s
growth or about the amount of fluid around your
baby you may require additional ultrasound scans.
There are other reasons for ultrasound scans in late pregnancy and these will be
discussed with you by your midwife/obstetrician. A detailed scan is performed on
women who are considered to be a high risk pregnancy.
Non-Invasive Prenatal Testing (NIPT)

DNA from the fetus circulates in the mother’s blood. Cell-free DNA (cfDNA) results
from the natural breakdown of fetal cells (presumed to be mostly placental) and
clears from the maternal system within hours of giving birth. During a pregnancy,
cfDNA can be tested to give the most accurate screening approach in estimating the
risk of a fetus having a common chromosome condition sometimes called a trisomy.
This occurs when there are three copies of a particular chromosome instead of the
expected two. The test looks to detect the following trisomies:
Trisomy 21 is the most common trisomy at the time of birth. Also called Down
syndrome, it is associated with moderate to severe intellectual disabilities and may
also lead to digestive disease, congenital heart defects and other malformations.
Trisomy 18 (Edwards syndrome) and Trisomy 13 (Patau syndrome) are associated
with a high rate of miscarriage. These babies are born with severe brain abnormalities
and often have congenital heart defects as well as other birth defects. Most affected
individuals die before or soon after birth, and very few survive beyond the first year
of life.
Sex Chromosome Conditions

The sex chromosomes (X and Y) determine whether we are male or female. X and Y
chromosome conditions occur when there is a missing, extra, or incomplete copy of
one of the sex chromosomes. The non invasive prenatal test with X, Y test can assess
risk for XXX, XYY, XXYY, XXY (Klinefelter syndrome), and a missing X chromosome
in a girl (Turner syndrome). There is significant variability in the severity of these
conditions, but most individuals have mild, if any, physical or behavioural features.
If the mother is interested in having this optional testing, she should talk with her
healthcare provider to determine if it is right for her. This option is not available for
8 twin pregnancies.
Risk
The testing is non-invasive: it involves taking a blood sample from the mother. The
pregnancy is not put at risk of miscarriage, or from other adverse outcomes that are
associated with invasive testing procedures such as amniocentesis.
Detection Rates
Clinical studies have shown that the NIPT has exceptional accuracy for assessing fetal
trisomy risk. A ‘high risk’ result is indicative of a high risk for a trisomy.
The test identifies in singleton pregnancies more than
 99% of fetuses with trisomy 21,
 98% of fetuses with trisomy 18
 80% of fetuses with trisomy 13
 96% of fetuses with Turner Syndrome.
 X and Y analysis provides >99% accuracy for fetal sex.
 Accuracy for detecting other sex chromosome anomalies varies by condition.
After the test, the number of women required to have a CVS or an amniocentesis is
less than 1%. It is important to note that if the test results show there is a high risk
that the fetus has trisomy 21, 18, 13 or sex chromosome conditions, it does not mean
that the fetus definitely has one of these conditions, although it is highly likely. For this
reason, in the event of a ‘high risk’ (or positive) result, follow-up testing by an invasive
procedure is recommended.
Will the mother need to have other tests?

The non-invasive prenatal test does not provide information on other physical defects
such as spina bifida, or information on fetal growth. It is therefore advisable that the
mother has all the usual ultrasound scans during her pregnancy.
Who can have the test?

The Non–Invasive Prenatal Test can be ordered by your obstetrician for women with
pregnancies of at least 10 weeks’ gestational age. It can also be ordered for all IVF
singleton pregnancies, including those with egg donors. Samples from pregnant
women with twins naturally conceived, or those conceived using the patient’s own
egg, are also accepted. This test does not assess risk for mosaicism, partial trisomies
or translocations. The results will be ready in approximately two weeks.
What happens if I decide to have NIPT?

Once the pregnant woman has made the decision to have the non-invasive prenatal
test performed, she will be asked to sign a consent form. Then a blood sample will be
taken from a vein in her arm. This test is not funded by the Health Service Executive
(HSE) or by Portiuncula University Hospital and is available to you at your own
expense. Please ask your midwife/obstetrician for more information about this test. 9
Your baby’s movements in pregnancy

What are normal movements for an unborn baby in pregnancy?
Most women are first aware of their baby moving when they are 18–20 weeks
pregnant. However, if this is your first pregnancy, you may not become aware of
movements until you are more than 20 weeks pregnant. If you have been pregnant
before, you may feel movements as early as 16 weeks. Pregnant women feel their
unborn baby’s movements as a kick, flutter, swish or roll.
As your baby develops, both the number and type of movements will change with
your baby’s activity pattern. Usually, afternoon and evening periods are times of peak
activity for your baby. During both day and night, your baby has sleep periods that
mostly last between 20 and 40 minutes, and are rarely longer than 90 minutes. Your
baby will usually not move during these sleep periods.
The number of movements tends to increase until 32 weeks of pregnancy and then
stay about the same, although the type of movement may change as you get nearer
to your due date. Often, if you are busy, you may not notice all of these movements.
Importantly, you should continue to feel your baby move right up to the time you go
into labour. Your baby should move during labour too.
Why are my unborn baby’s movements important?

During your pregnancy, feeling your baby move gives you reassurance of his or her
wellbeing. If you notice your baby is moving less than usual or if you have noticed a
change in the pattern of movements, it may be the first sign that your baby is unwell
and therefore it is essential that you contact your midwife or local maternity unit
immediately so that your baby’s wellbeing can be assessed.
How many movements are enough?

There is no specific number of movements which are normal. During your pregnancy,
you need to be aware of your baby’s individual pattern of movements. A reduction or
a change in your baby’s movements is what is important.
What factors can affect me feeling my baby move?

You are less likely to be aware of your baby’s movements when you are active or busy.
If your placenta (afterbirth) is at the front of your uterus (womb), it may not be so
easy for you to feel your baby’s movements.
Your baby lying head down or bottom first will not affect whether you can feel it move.
If your baby’s back is lying at the front of your uterus, you may feel fewer movements
10 than if his or her back is lying alongside your own back.
What can cause my baby to move less?

Certain drugs such as strong pain relief or sedatives can get into an unborn baby’s
circulation and can make your baby move less. Alcohol and smoking will also affect
your baby’s movements. In some cases, a baby may move less because he or she
is unwell. Rarely, a baby may have a condition affecting the muscles or nerves that
causes him or her to move very little or not at all.
What if I am unsure about my baby’s movements?

If you are unsure whether or not your baby’s movements are reduced, you should lie
down on your left side and focus on your baby’s movements for the next 2 hours. If
you do not feel ten or more separate movements during these 2 hours, you should
ring and attend your maternity department for assessment.
What should I do if I feel my baby’s movements are reduced or

changed?
Always seek professional help immediately. Never go to sleep ignoring a reduction
in your baby’s movements. Do not rely on any home kits you may have for listening
to your baby’s heartbeat. The care you will be given will depend on the stage of your
pregnancy:
Less than 24 weeks pregnant

Most women first become aware of their baby moving when they are 18–20 weeks
pregnant. If by 24 weeks you have never felt your baby move, you should contact
your maternity unit who will check your baby’s heartbeat. An ultrasound scan may be
arranged and you may be referred to a specialist fetal medicine centre to check your
baby’s wellbeing.
Between 24 weeks and 28 weeks pregnant

You should contact your maternity unit who will check your baby’s heartbeat. You
will have a full antenatal check-up that includes checking the size of your uterus,
measuring your blood pressure and testing your urine for protein. If your uterus
measures smaller than expected, an ultrasound scan may be arranged to check on
your baby’s growth and development.
11
Over 28 weeks pregnant

You must contact your maternity unit immediately. You must not wait until the next
day to seek help. You will be asked about your baby’s movements. You will have a full
antenatal check-up, including checking your baby’s heartbeat.
Your baby’s heart rate will be monitored, usually for at least 20 minutes. This should
give you reassurance about your baby’s wellbeing. You should be able to see your
baby’s heart rate increase as he or she moves. You will usually be able to go home
once you are reassured.
An ultrasound scan to check on the growth of your baby, as well as the amount of
amniotic fluid around your baby, may be arranged if:
• your uterus measures smaller than expected
• your pregnancy has risk factors associated with stillbirth
• the heart-rate monitoring is normal but you still feel that your baby’s movements
are less than usual.
The scan is normally performed within 24 hours of being requested.

These investigations usually provide reassurance that all is well. Most women who
experience one episode of reduction in their baby’s movements have a straightforward
pregnancy and go on to deliver a healthy baby.
If there are any concerns about your baby, your doctor and midwife will discuss this
with you. Follow-up scans may be arranged. In some circumstances, you may be
advised that it would be safer for your baby to be born as soon as possible. This would
depend on your individual situation and how far you are in your pregnancy.
What should I do if I find my baby’s movements are reduced again?

When you go home you will be advised to be aware of your baby’s movements. Should
your baby have another episode of reduced movements, you must again contact your
maternity unit immediately. Never hesitate to contact your maternity unit for advice,
no matter how many times this happens.
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Vaccines & Pregnancy

Prior to Becoming Pregnant
MMR vaccine
Before getting pregnant, a woman should ensure that she is immune to infection from
rubella (German measles). Rubella infection during pregnancy may cause miscarriage
or stillbirth. Nine out of ten babies will have major birth defects such as deafness,
blindness, brain damage or heart disease. This is known as Congenital Rubella
Syndrome. Immunity to rubella can be checked by your GP. Vaccination is the only
way to prevent Congenital Rubella Syndrome. The MMR vaccine provides immunity
to infection from Rubella. If you need to get vaccinated for rubella, you should avoid
getting pregnant until one month after receiving the vaccine and ideally not until your
immunity is confirmed by a blood test.
During pregnancy
The immunity developed by a mother after vaccination during pregnancy is passed
on to her baby in the womb. This immunity helps protect the baby during the first few
months of life. Vaccines recommended in pregnancy include;
Flu Vaccine
Influenza is a highly infectious acute respiratory
illness caused by the influenza virus. Influenza affects
people of all ages, outbreaks of influenza occur almost
every year, usually in winter. This is why it is also
known as seasonal flu. Pregnant women are more
likely to get complications from flu due to changes in
their heart and lung function. A pregnant woman who
gets the flu is at risk for serious respiratory illness and
complications. Getting flu in pregnancy can also lead
to premature birth and smaller babies. Flu vaccination
during pregnancy provides immunity against influenza
infection to babies in the first 6 months of life. The flu
vaccine is inactive and can be given safely at any time
during pregnancy
13
Whooping Cough Vaccine

Whooping cough (also known as pertussis) is a
highly contagious illness that can be life threatening.
The disease is most serious in babies less than 6
months of age - many babies are hospitalised with
complications such as pneumonia and brain damage.
Babies less than 6 months of age are too young to be
fully vaccinated.
Whooping cough causes long bouts of coughing and

choking making it hard to breathe. The ‘whoop’ sound
is caused by gasping for air between coughing spells.
A child with whooping cough may turn blue from lack
of air, or vomit after a coughing spell. Not all children
get the ‘whoop’ and often older children and adults
just have a cough. The disease can last up to three
months. Infection with whooping cough does not give long lasting protection so re-
infections can happen.
Women should get whooping cough vaccine during each pregnancy. The mothers’
immunity to whooping cough wane during pregnancy and is unlikely to protect the
baby. Vaccination is recommended between 27 and 36 weeks of pregnancy. This is
considered the best time in pregnancy to provide protection for the baby during the
first few months of life.
Varicella Zoster Immune Globulin

If you are not immune to chickenpox and you come into contact with it during
pregnancy, you may be given an injection of varicella zoster immune globulin (VZIG).
This is a human blood product that strengthens the immune system for a short time,
although it may not prevent chickenpox developing. It is safe to have in pregnancy.
Further information is available on www.immunisation.ie
14
Your health in Pregnancy

Healthy Eating for Pregnancy
What is a well-balanced diet?
A healthy diet is important for both you and your baby
before, during and after your pregnancy.
This ensures you have a good store of nutrients to
meet the demands of your developing baby. Being
pregnant does not mean you need to eat for two.
The following tips can help keep you and

your baby healthy:
If you are already on a special diet for medical reasons,
make sure to consult your doctor or dietician.
• Eat regular meals daily
• Try not to eat too many foods that are high in fat and sugar e.g. cakes, biscuits,
buns, crisps, chocolate, fizzy drinks.
• Keep snacks to fruit, wholegrain crispbreads, sugar free jelly, diet natural yogurt
e.g. muller light, Tesco healthy living, Yoplait 0% Irish yogurts diet varieties.
• Try to avoid frying or deep-frying food.
• Try to keep as active as possible.
How much should I eat?

The extra energy you need in pregnancy can easily be met by including 1-2 extra
healthy snacks each day. Weight loss is not recommended during pregnancy instead
try to avoid excessive weight gain.
Being overweight (Body Mass Index/BMI=25-29.9kg/m2) or obese (BMI= greater

than 30kg/m2) can increase your risk of;
• Miscarriage
• Gestational Diabetes
• Pre-eclampsia
• Emergency and Elective Caesarean Section
• Big/small baby
• Deep vein thrombosis (clots).
• Intrauterine death
Therefore, it is important to eat healthy and keep active to prevent you gaining too
much weight during your pregnancy.
For more information on suitable foods and portions, see the table overleaf.
http://www.healthyireland.ie 15
6+
5+
16
Healthy fats
Use mainly monounsaturated and polyunsaturated oils in cooking, such as olive,
rapeseed and sunflower oils. Use small amounts of butter and enjoy nuts, seeds, oily
fish and avocado as heart-healthy additions.
Do not skip meals!
Always take regular meals and snacks, evenly spaced throughout the day. This makes
it easier to include all the foods needed for a balanced diet and will help keep your
energy levels up. It can also help keep nausea at bay.
Vitamins and Minerals

Iron
Iron is necessary for healthy blood. Good dietary sources include meat, fish, poultry
and egg yolks, green leafy vegetables, fortified breakfast cereals, peas, beans and
lentils. In addition, foods rich in Vitamin C such as citrus fruits (oranges, grapefruit)
can help the absorption of iron from your food, whereas strong tea or coffee can
prevent it. Because of the high requirements of iron during pregnancy, your doctor
may prescribe iron tablets for you if necessary.
Folic acid (folate)

Folic acid (folate) is really important to reduce the risk of Spina Bifida and other neural
tube defects. You will get a certain amount of folate from food, for example, green
leafy vegetables, citrus fruits, wholegrains, legumes and foods fortified with folic acid
(some breads and milks). You should take folic acid 400mcg for one month before
you become pregnant and for the first 12 weeks of your pregnancy.
If your risk of having a baby with spina bifida is higher than normal, you will be advised
to take a daily dose of 5 milligrams (mg) of folic acid. This will need to be prescribed
by a doctor.
You may be advised to take an increased dose if:
• you have had a previous pregnancy affected by spina bifida

• you or your partner have spina bifida
• you are taking certain medications for epilepsy
• you have coeliac disease or diabetes
• you are obese (BMI is 30 or more)
• you have sickle-cell anaemia or thalassemia
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Calcium
Calcium is essential for the development of healthy teeth and bones. Good dietary
sources include milk, yoghurt and cheese. Smaller amounts are found in green
vegetables, and tinned fish like sardines and salmon. If you don’t like milk, cheese or
yoghurt, discuss alternative sources with your doctor or dietician.
Vitamin D
Vitamin D is really important for you and your baby. Because we get very little Vitamin
D from food it is best to take a pregnancy multivitamin that contains Vitamin D e.g.
Pregnacare, Sanatogen Mum To Be, Seven Seas Pregnancy. The following foods also
contain some vitamin D:oily fish (salmon, mackerel, trout, herring, sardines) eggs,
some fortified milks and cereals.
Omega-3
Omega-3 has been shown to improve babies brain development. The best source
is oily fish e.g. Salmon, trout, mackerel, sardines, kippers and herring. All pregnant
women should try to have oily fish 1-2 times per week
Avoid ‘dieting ‘in pregnancy, for further information on healthy eating refer to the
‘Healthy Eating for Pregnancy’ booklet and also www.healthpromotion.ie
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Take care with some foods

Vitamin A
Too much vitamin A is not recommended in pregnancy. Avoid cod liver oil supplements,
liver and liver products.
Caffeine
Limit your caffeine intake to less than 200mg per day, this equates to 2-4 mugs of
tea or 2 cups of coffee or 1000ml cola or 500ml energy drink or 4 bars of chocolate
(FSAI, 2011). Try choosing decaffeinated versions.
Toxoplasmosis
The Toxoplasmosis parasite is found in mammals, especially cats and birds. It is
estimated that 30 per cent of humans are infected. Primary infection in pregnancy
may lead to infection of the baby in the womb.
Toxoplasmosis is a very severe infection for unborn babies and for people with lowered
immunity. If you’re pregnant or have a weakened immune system you should:
• Avoid contact with cat faeces and soil. Wear gloves when handling soil and cat
litter. (cat litter trays should be emptied daily).
• Cook raw meats and ready –prepared chilled meats thoroughly.
• Wash fruit and vegetables well before eating.
• Eliminate cross-contamination from raw foods to cooked foods by thoroughly
washing hands, cutting boards, knives and other utensils.
If symptoms do develop (usually a mild illness with fever, headache, muscle aches
and enlarged lymph nodes) contact your doctor.
Listeriosis
Listeriosis is rare (less than one per cent of food borne infections) but serious
infection caused by eating food contaminated with bacteria called listeria can lead to
miscarriage, stillbirth, premature delivery, or infection in newborns. Infected pregnant
women may experience a mild, flu-like illness.
Symptoms may vary but include:
• fever and chills
• headache
• stiff neck and sensitivity to light
• confusion and drowsiness
• muscle aches and pains
• nausea (feeling sick)
• diarrhoea.
19
What are high risk foods?

High risk foods are usually chilled ready-to-eat foods. Avoid eating mould ripened
soft cheese such a Camembert, Brie or blue-veined cheeses, unpasteurised dairy
products; soft-serve ice-cream; chilled seafood and pâté.
What foods are safe?

All freshly cooked foods, hard cheeses, fresh pasteurised milk and milk products, long
life UHT milk, yoghurt, freshly washed vegetables and fruit, and canned foods are
usually considered safe.
How can food be prepared safely?

Refrigeration does not stop the growth of listeria. High risk foods that have been
prepared and then stored in a refrigerator for more than 12 hours should not be eaten
by pregnant women or other susceptible people.
• Freshly cooked foods are safest. Conventional cooking destroys listeria.
• Hot food should be thoroughly cooked and kept hot above 60 °C.
• Raw vegetables should be thoroughly washed before eating.
• Eat leftovers within 24 hours and reheat to above 74°C for over two minutes
• Uncooked meats should be kept covered and separate from cooked foods and
ready-to-eat food to avoid cross-contamination.
• Knives and cutting boards used to prepare uncooked foods should not be used to
prepare cooked or ready-to-eat foods unless thoroughly washed first.
Salmonella
• Avoid eating raw or partially cooked eggs or food that may contain them, such
as homemade mayonnaise, cold desserts made with raw fresh eggs e.g. tiramisu
and mousse. Check the packaging of the food to see what is in it.
• Avoid eating raw or partially cooked meat especially poultry and shellfish.
20
Exercise and pregnancy

There are many physical and psychological
health benefits to remaining physically active
throughout your pregnancy. The American
College of Obstetricians and Gynaecologists
(ACOG, 2015) recommend that women
with uncomplicated pregnancies should be
encouraged to engage in aerobic and strength
–conditioning exercises before, during and
after pregnancy.
Benefits of pregnancy exercise

include
• Improved posture which helps relieve lower back pain
• Improved circulation leading to reduction in swelling of the feet, ankles and
decrease in cramping of the legs.
• Increased muscle tone, flexibility, strength and endurance.
• Promotes sense of wellbeing, reduces anxiety.
• Promotes relaxation and improves sleep.
• Increased energy levels and helps prevent excessive weight gain
What Exercise is recommended during pregnancy?

Aerobic and strength conditioning exercises are recommended in pregnancy.
Examples of aerobic (cardiovascular) exercise include walking, jogging, swimming,
aqua aerobics or gym cardio machines. Examples of strength conditioning exercise
include; using light weights, resistance bands or attending a pilates or yoga class. It is
also recommended to commence pelvic floor exercise as early as possible.
21
What Exercise is NOT recommended during pregnancy?

You can discuss any specific exercise with your GP to clarify any risk and modify if
necessary. You should avoid any contact sport as they increase the risk of abdominal
injury. You should also avoid exercise that have a high risk of falling. These
include cycling, horse riding, skiing and gymnastics. As your pregnancy progresses
your balance and coordination will change and you need to modify your exercise
accordingly.
What is the recommended duration and frequency of exercise?

Usually, 30 minutes exercise on most, if not all, days of the week is recommended. If
30 minutes in the same session is not possible, then this time can be divided into 10
or more minute sessions to make up 30 minutes e.g. 3 x 10 minute sessions or 2 x 15
minute sessions.
Make sure you do a warm-up and cool-down. Do the ‘talk test’. While exercising you
should always be able to carry out a conversation. If you are too breathless to do this
you are exercising too hard.
Ensure you drink plenty of water and are adequately nourished. Include a gradual
warm up and cool down and rest afterwards.
Stop exercising and discuss with your doctor if you develop any of
the following,
Vaginal bleeding, regular painful contractions, shortness of breath before exercise,
dizziness or feeling faint, palpitations or chest pain, headache, muscle weakness
affecting balance, calf pain/swelling.
Exercises for the Pelvic Floor and Stomach muscles

Exercises for the pelvic floor and stomach muscles
are aimed at improving the stability of the pelvis and
back and form a large part of treatment and are safe
to continue throughout the pregnancy.
The pelvic floor is comprised of the muscles,

ligaments, connective tissue and nerves that support
the bladder, uterus, vagina and back passage. It
maintains bladder and bowel control including when
you cough, sneeze or hold heavy objects. It plays a
vital role along with other muscles in supporting the
22 spine It has a key role in assisting pushing phase of
delivery. It can be weakened during pregnancy due to constipation, increased pressure

as a result of weight of baby on the pelvic floor and the effect of relaxin.
• Women who perform exercises antenatally have stronger muscles postnatally.

• Start these exercises as early as possible in your pregnancy.
• It is important for all women to practice pelvic floor exercises after delivery even
if you have a caesarean section.
Transversus Abdominus
This is your deepest abdominal muscle. It is like you body’s natural corset. It works
gently all day long to support your abdomen. By doing this it gives support to your
back and pelvis.
The easiest way to start this exercise is lying on your side. Once it becomes easier
you can practise in sitting and standing.
• Lie on your side, hands just below your belly button on either side of your tummy.
• Let your tummy sag and gently breathe in.
• As you breath out, draw your lower tummy in towards your back away from your
hands, as if you were pulling up a zipper of your pants.
• Aim to hold for 3 seconds and progress to 10.
• You should be able to breathe and talk while doing this exercise.
• Start with 4-5 repetitions and increase the number of times you repeat this
exercise to 10 times
• Do little and often during the day
• You may feel your pelvic floor muscles working while doing this exercise. This is
normal as both muscles work together to support your back and pelvis
23
Pelvic Floor Exercises

• Tighten the muscles around your vagina and back passage
• Lift up imagining you are stopping the flow of urine or holding wind in the back
passage.
• Think of the direction going from the back passage all the way up to the tummy
button.
• Feel a squeeze and lift sensation.
• Do not hold breath or squeeze buttocks or legs.
• Continue to lift for as long as you can up to 10 seconds. Then fully release.
Repeat as many times as you can up to a maximum of 10 repetitions.
• You should feel your pelvic floor muscles ‘lift up’ inside you and feel a definite ‘let
go’ as the muscles relax.
• It is also important that the muscles are able to react quickly to stop you leaking
when you cough or sneeze. Practice tightening hard and quickly, then relaxing.
Do this rapidly several times. Do not try to hold on to the contraction, just
squeeze and let go.
• Try to practice these hourly (little and often)
• You can exercise your pelvic floor muscles any time, lying, sitting, standing, doing
daily activities or feeding your baby.
• You may find it difficult to isolate these muscles at first but you will continue to
improve as you practice.
• If you do continue to have any symptoms of incontinence at the time of your 6
week check you should discuss with your doctor and they will arrange a referral
to Physiotherapy.
24
Pelvic Tilts
Breathing normally, lying on your back with your arms by your side. Tighten your
stomach muscles and press the small of your back against the floor, letting your tail
bone rise. Hold for a count of 5 seconds exhaling slowly. Can also be done on your
side, sitting on gym ball or standing
For further advice and information about physical activity log on to

www.getirelandactive.ie
25
Posture
It is very important as your pregnancy progresses to maintain good posture and avoid
over arching your lower back. This can cause low back pain and make the symptoms
of Pelvic Girdle Pain (PPGP) worse. Poor posture aggravates heartburn, breathlessness
and rib pain.
26
Standing
• It is important to stand upright, tuck in your stomach and buttocks and straighten
your spine.
• Try to avoid over-arching your lower back.
• Avoid slouching.
• Keep knees straight not locked.
• Counteract changes by contracting abdominal and buttock muscles.
• Avoid prolonged standing.
• Put alternate foot on stool / step when standing for long period.
Sitting
Sit tall on firm chair, hips and knees at 90° angle.
Use a lumbar roll / rolled up towel or pillow for back support.
Watch driving position, posture when working at a desk.
Lying Positions
Semi-reclined:
Stack pillows behind your head and pillow
under knees
Side lying
Place pillow between knees and a small
cushion / towel under your tummy to
support your bump
27
Optimal Fetal Positioning

The way your baby is positioned in your pelvis has a huge influence on your labour
and birth. Optimal fetal positioning (OFP) describes movements and positions that
mothers can do during pregnancy and labour to encourage babies to enter into a
favourable position for birthing. This is not a new concept; however, the modern world
has led us into a more sedentary lifestyle. Driving cars, working at desks, slouching on
couches with laptops and watching TV all of which contribute to imbalance that can
cause misalignment within our bodies.
For birth we need to ensure the body doesn’t inhibit the babies’ natural ability to rotate
and manoeuvre his/her way down through your pelvis and birth canal. The goal is to
have a baby head down, their back to your front and with a tucked chin, presenting
the smallest part of the head into the pelvis for an easier passage of birth. Practicing
optimal fetal positioning during the last six weeks of pregnancy is non-invasive and
includes the use of appropriate maternal postures and exercises that encourage your
unborn baby to move into a position where his head can move through your pelvis
without restriction.
So what can I do?

Avoid positions which encourage your baby to face your tummy. The main culprits are
said to be lolling back in armchairs, sitting in car seats where you are leaning back, or
anything where your knees are higher than your pelvis.
The best way to do this is to spend lots of time kneeling upright, or sitting upright, or
on hands and knees.
28
• When you sit on a chair, make sure your knees are lower than your pelvis, and
your trunk should be tilted slightly forwards.
• Watch TV while kneeling on the floor, over a beanbag or cushions, or sit on a
dining chair.
• Try sitting on a dining chair facing (leaning on) the back as well.
• Use yoga positions while resting, reading or watching TV - for example, tailor
pose (sitting with your back upright and soles of the feet together, knees out to
the sides)
• Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the
seat back upright.
• Don’t cross your legs! This reduces the space at the front of the pelvis, and opens
it up at the back. For good positioning, the baby needs to have lots of space at
the front
• Don’t put your feet up! Lying back with your feet up encourages posterior
presentation.
• Sleep on your side, not on your back
• Avoid deep squatting, which opens up the pelvis and encourages the baby to
move down, until you know he/she is the right way round. Squat on a low stool
instead, and keeping your spine upright, not leaning forwards.
• Swimming with your belly downwards is said to be very good for positioning
babies - not backstroke, but lots of breaststroke and front crawl. Breaststroke
in particular is thought to help with good positioning, because all those leg
movements help open your pelvis and settle the baby downwards.
• A Birth Ball can encourage good positioning,

both before and during labour. The vinyl
ball can be used to relax the pelvis. During
pregnancy the birth ball will be used as a seat.
Place the ball on a clean floor free of debris and
sharp objects. A chair or solid piece of furniture
should be nearby to steady the user when
getting on and off the ball. The pregnant woman
will sit on the ball with her feet approximately
20-25 inches apart. A partner can help her to
get on and off the ball the first few times she
is using the ball. When seated on the birth ball
the expecting mother can rock side to side,
back to front and use a combination of circular
and figure eight motions with the ball.
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Common pregnancy symptoms

Heartburn & Indigestion
Hormones and the pressure of the growing uterus cause indigestion and heartburn.
Pregnancy hormones slow the muscles of the digestive tract, so food tends to move
more slowly causing digestion to become sluggish. This can make many pregnant
women feel bloated. Hormones also relax the valve that separates the oesophagus
from the stomach. This allows food and acids to come back up from the stomach to
oesophagus. The food and acid causes the burning feeling of heartburn. As your baby
gets bigger the uterus pushes on the stomach making the heartburn more common
in later pregnancy.
What can I do to help?

• Eat several small meals instead of three large meals
• Eat slowly
• Drink fluids between meals not with meals
• Don’t eat greasy and fried foods
• Avoid citrus fruits or juices, coffee, drinks containing caffeine and spicy foods.
• Drink peppermint tea, milk or ginger ale.
• Do not eat or drink within a few hours of bedtime.
• Do not lie down right after meals
• Propping yourself up with pillows can help reduce symptoms
Nausea and vomiting of pregnancy

Nausea and vomiting is a symptom of pregnancy and affects most women to some
degree. It begins early in pregnancy, most commonly between the 4th and 7th week.
It usually settles by 12–14 weeks, although in some women it may last longer. It is
often called ‘morning sickness’ but it can occur at any time of the day or night. The
cause is thought to be pregnancy hormones but it is unclear why some women get it
worse than others. However, it is more likely if
• you have had it before
• you are having more than one baby (twins or triplets)
• You have a molar pregnancy (a rare condition where the placenta overgrows and
the baby does not form correctly).
It is important that other causes of vomiting are considered and looked into,
particularly if you are unwell, have pain in your tummy or your vomiting only starts
after 10 weeks of pregnancy.
Possible other causes include gastritis (inflammation of the stomach), a kidney
30 infection, appendicitis or gastroenteritis.
Most women with nausea and vomiting of pregnancy will be able to manage their
symptoms themselves.
You should:
• Eat small amounts often – meals that are high in carbohydrate and low in fat,
such as potato, rice and pasta, are easier to tolerate; try plain biscuits or crackers
• Avoid any foods or smells that trigger symptoms.
• Some women find eating or drinking ginger products helps. However, these may
sometimes irritate your stomach.
• Complementary therapies such as acupressure or acupuncture may also be
helpful.
If your symptoms do not settle or if they prevent you doing your day-to-day activities,
see your GP, who will prescribe anti-sickness medication. This is safe to take in
pregnancy.
Severe Morning Sickness

If the nausea and vomiting becomes so severe that it leads to dehydration and
significant weight loss, it is known as hyperemesis gravidarum. It may affect 1 to 3
in 100 pregnant women. Signs of dehydration include feeling ‘dry’ or very thirsty,
becoming drowsy or unwell, or your urine changing from a light yellow to a dark yellow
or brown colour. Women with this condition may need to be admitted to hospital. In
severe cases, vomiting can last up to 20 weeks. Occasionally, it can last until the end
of pregnancy
Itching
Itching is common in pregnancy. Usually it’s thought to be caused by raised levels of
certain chemicals in the blood, such as hormones. About 20% of pregnant women
feel itchy during pregnancy.
Later on, as your bump grows, the skin of your tummy (abdomen) is stretched and
this may also feel itchy. However, itch on palms of hands and soles of feet can be a
symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also
known as obstetric cholestasis (OC).
31
Dealing with Mild Itching

• Wearing loose clothes may help prevent itching, as your clothes are less likely to
rub against your skin and cause irritation.
• You may also want to avoid synthetic materials and opt for natural ones, such
as cotton, instead. These are “breathable” and allow the air to circulate close to
your skin.
• You may find having a cool bath or applying lotion or moisturiser can help soothe
the itching.
Some women find that products with strong perfumes can irritate their skin, so you
could try using unperfumed lotion or soap.
Mild itching is not usually harmful to you or your baby, but it can sometimes be a
sign of a more serious condition, particularly if you notice it more in the evenings or
at night.
Let your midwife or doctor know if you are experiencing itching so they can decide
whether you need to have any further investigations.
Cramps
Cramp is a common complaint especially in the
third trimester due to increased weight gain of
pregnancy and changes in circulation.
To help prevent cramps and ease them when
they occur you should try exercise regularly and
keep hydrated.
If you feel cramp developing it can be prevented
by pulling your toes towards you.
A calf stretch is another good way to keep calf
stretched and help alleviate and prevent cramps.
It is good to do stretches before bed if leg
cramps are a problem at night.
• Lean against wall with one leg out behind

and heel on floor
• Lean into wall and stretch the calf
• Hold for 30 seconds and repeat 5 time
32
Rib Pain
Rib pain is another common complaint. This can be aggravated by flexed postures,
driving and desk work. It is caused by the expanding uterus pushing the diaphragm
upwards and the ribs outwards. It normally eases as the baby descends in to the
pelvis during the last few weeks of pregnancy or if not after delivery.
It can be relieved by posture correction, changing position regularly and sitting on a
gym ball
Upper Body Stretch

Sit comfortably on the floor or on a chair.
Lift your right arm over your head with your

palm facing your left side.
Gently stretch to the left from the waist.

Remember to stop as soon as you feel a stretch
on your right side.
Hold your stretch for 15-30 seconds and repeat

2-3 times on each side.
Take care not to overstretch.
33
Carpal Tunnel
Carpal tunnel is also common during pregnancy especially
in the third trimester. It is caused by excess fluid which
can cause compression of the median nerve as it passes
through the narrow carpal tunnel to the hand.
Symptoms are pain and weakness in the thumb and first
two fingers accompanied by tingling. It is most commonly
experienced at night, disturbing sleep.
This can be relieved by elevation of hands to try to prevent
swelling, positioning hands in neutral (avoiding excessive
flexion) and provision of splints to limit flexion, especially
for use at night.
Pregnancy–Related Pelvic Girdle Pain (PPGP)
Some women develop pelvic pain in Pregnancy. This is sometimes called pregnancy
related pelvic girdle pain (PPGP) or symphysis pubis dysfunction (SPD). PPGP is
common, affecting 1 in 5 women. It describes pain in the joints that make up the
pelvic girdle, including the symphysis pubis at the front and the sacroiliac joints at
the back.
It is caused by the hormone relaxin causing laxity of the pelvic joints in preparation
for labour and delivery. It is not harmful for the baby but can cause discomfort and
pain for you.
34
Symptoms of PPGP
The symptoms and severity of PPGP can vary greatly in different women and may
require referral to physiotherapist. Symptoms can include:
• Pain over the pubic bone in the centre, groin and inner thighs
• Pain across one or both sides of your lower back or hips
General advice tips during pregnancy:

• Be as active as possible within the limits of pain
• Avoid activities that make the symptoms worse
• Rest when you can
• Sit to get dressed and undressed
• Stand with equal weight through both legs
• Avoid / reduce non-essential weight bearing activities – stairs, shopping, lifting
or asymmetrical activities such as carrying toddlers on one hip
• Go upstairs one leg at a time leading with the pain-free leg first.
• If painful, try to keep your legs together when getting in and out of the car –
placing a plastic bag on the seat may help you to swivel
• Lie on the less painful side while sleeping– use a pillow under your bump and
between your legs and feet
• When turning in bed it can help to bend your knees and keep them together.
Tighten your tummy muscles and pelvic floor before you turn in order to stabilise
the joint and give some compression.
Management of PPGP, during labour and delivery

Most women with PGP have a normal vaginal delivery. Make sure that your
Consultant/Midwife is aware of your symptoms. Keep upright for as long as possible
during labour. Measure how far apart your knees will open before pain is experienced
– keep your legs within this pain-free range as much as possible during labour and
delivery.
Management of PPGP, after your baby is born

It is important that pain relief is effective and given regularly if required. Most of the
discomfort and pain related with PPGP will settle in the first few days after delivery and
continue to improve over the first 2-3 months after delivery. A very small percentage
of women may continue to have symptoms. By the 6 week check you should feel
significantly better but if symptoms persist discuss with your doctor and they will
arrange a referral to Physiotherapy.
Chartered Physiotherapists in Women’s Health & Continence (CPWHC)

www.iscp.ie 35
Lifestyle Advice
Pregnancy and Alcohol
Why should I avoid alcohol during pregnancy?
Alcohol can damage your baby’s developing brain
and body. Drinking while pregnant doesn’t mean your
baby will definitely be harmed, but it can happen, and
the effects may not be evident at birth.
What harm does alcohol do?

Alcohol causes two types of problems: foetal alcohol
spectrum disorders (FASD), and foetal alcohol
syndrome (FAS).
What problems does FASD cause?

FASD causes problems with a baby’s body, brain,
behaviour and can cause problems throughout a
person’s life. For example:
• Hyperactivity and poor attention,
• Learning difficulties and a lower IQ,
• Difficulty controlling behaviour,
• Difficulty getting along with other people
• Being smaller than expected,
• Problems with eating and sleeping,
• Emotional and mental health problems.
What is FAS?
Foetal alcohol syndrome (FAS) is more serious and can happen when you drink
heavily during your pregnancy. In addition to all the signs of FASD listed above, your
baby may:
• be smaller than normal or underweight,
• have damage to their brain and spinal cord,
• have an abnormally small head or eyes, abnormally-shaped ears or facial features,
• have problems with their heart and genitals.
36
Can FAS and FASD be cured?

There is no cure for FASD or FAS. Diagnosing and treating the symptoms early can
help a child to manage better. FAS and FASD are only caused by alcohol. An alcohol-
free pregnancy means there is no risk of FASD or FAS.
Drinking heavily during pregnancy can also increase the chances of complications
during pregnancy and childbirth, as well as increasing the risk of premature delivery,
miscarriage and stillbirth.
There is no known safe level of alcohol use in pregnancy; therefore it is

advised not to drink alcohol during pregnancy
Visit askaboutalcohol.ie for more information about alcohol and pregnancy, and to
find details of support services.
Smoking in Pregnancy
Stopping smoking is the single most important thing you can do to protect your
health. If you are pregnant, giving up will help protect your baby’s health too.
Portiuncula University Hospital is a smoke-free campus which means that smoking is
not permitted anywhere on the grounds including all the areas around the Hospital.
It may be helpful to contact your GP in advance of your stay at Portiuncula University

Hospital for advice on smoking cessation support options or nicotine replacement
therapy.
Further information is available on: www.quit.ie and search ‘pregnancy.
Medicines
Research shows that over-the-counter medicines you use in pregnancy can influence
your child later in life. Even medicines that don’t seem to do you any harm may be
damaging to your baby. Take as few medicines as possible, and only where the benefit
from taking them outweighs the risk.
Always tell any doctor, dentist, midwife or pharmacist that you are pregnant.
Remember to seek advice from your health professional before taking any medication
or alternative therapies in pregnancy.
37
Drugs in Pregnancy
Drugs can be harmful to a developing fetus throughout the pregnancy. During the
first three months the major organs and limbs of the baby are forming. This time
is considered a higher risk period for deformities. Drugs that are of a concern in
pregnancy include: alcohol, tobacco, marijuana, amphetamines, heroin, cocaine,
tranquillisers and sleeping pills, painkillers, LSD, ecstasy and other designer drugs,
glues and aerosols.
Some prescription drugs and herbal treatments can also be a problem during
pregnancy, so discuss this with your doctor. All drugs taken during pregnancy will
reach the baby through the placenta. There is an enormous variation in the baby’s
responses to these drugs. You may know someone who has had what appears to be a
healthy baby even though they took drugs during their pregnancy. You cannot assume
that your baby will be healthy if you take drugs during your pregnancy. No-one can
predict how your baby will be affected, particularly in the long term.
Further information is available on: www.drugs.ie
Travel during pregnancy

Car Travel
Place the seat belt over your shoulder and chest (between your breasts) without
impinging on your abdomen. The lap strap should lie across your upper thighs. Neither
strap should go over your bump.
Air Travel
Long-haul air travel is associated with an increased risk of venous thrombosis. Discuss
flying, vaccinations and travel insurance with your doctor before you make your plans
to travel abroad.
For more information see: ‘pregnancy care’ and ‘lifestyle’ on www.hse.ie/healthaz
38
Domestic Abuse
Pregnancy is usually an exciting and special time in a woman’s life. While you cherish
the new life growing inside you, those around you care for and cherish you. But for
some women this is not the case.
Pregnancy can be a stressful and fearful time if you are experiencing abuse in your
relationship.
If you are experiencing abuse in your relationship, you are not alone.
Sadly, it is very common. In a survey conducted by the Rotunda hospital found that 1
in 8 women surveyed were being abused by their partner. It is also known that 25% of
women who experience domestic violence are physically assaulted for the first time
during pregnancy.
Domestic violence can be described as the ‘use of physical or emotional or threat

of physical force including sexual violence’, in close adult relationships. Domestic
violence can also involve emotional abuse, the destruction of property, isolation
from friends, family and other potential sources of support, threats to others
including children, stalking, and control over access to money , personal items, food,
transportation and the telephone.
In Portiuncula we are concerned for the health and safety of all our patients and it is
safe place to ask for help or information as required.
If you wish to speak to a social worker, please ask your midwife or doctor who will
make contact with the department on your behalf.
To find out more information on domestic abuse and violence and services that can
help, log onto website www.whatwouldyoudo.ie
Women’s aid 24hrs National Freephone helpline number 1800 341 900
www.womensaid.ie
39
Infections in Pregnancy
Group B Streptococcus
Group B streptococcus (GBS) is a very common bacterium. It occurs naturally in many
people. It typically causes no harm or symptoms. Up to one in three people carry GBS
in the gut (bowel) and in women it may be found in the vagina (birth canal). It is
usually intermittent in nature i.e. it can come and go. GBS is not sexually transmitted,
nor is it a sign of ill health or poor hygiene.
What is GBS infection?

Although GBS carriage in an adult is not serious, it can lead to GBS infection in babies
before, during or shortly after birth. This infection may cause serious complications
and can even be life-threatening. Many babies are exposed to GBS, but only those
susceptible to the bacterium will become infected. It is not known why some babies
are susceptible and others are not.
How do I know if I am carrying GBS?

Vaginal GBS colonisation has no symptoms and can be intermittent (i.e. may come
and go). It is possible to screen for GBS. If a test is done, the most sensitive method
of detection requires swabs from the vagina and rectum that are cultured in the
laboratory. However routine screening for the detection of GBS in pregnancy is not
carried out in Portiuncula Hospital. Currently the evidence suggests that screening all
pregnant women routinely may not be beneficial overall.
GBS may also be detected on a laboratory sample of urine. Antibiotics will be given at
the time of detection if GBS is found in a sample of urine. Carrying GBS in pregnancy
does not automatically mean that a baby will develop GBS infection.
Risk Factors
There are 4 situations where a woman may need antibiotics in labour to help prevent
GBS infection in her baby
• Previous baby affected by GBS disease.
• Mothers who have been found to carry GBS on vaginal swab or in their urine in
pregnancy.
• Where a woman has a raised temperature in labour (38 degrees C or higher)
• Preterm labour (labour starts before 37 weeks of pregnancy)
40
Some situations are regarded as higher risk than others.

Depending on your circumstance your healthcare professional will discuss
the option of antibiotic treatment during labour.
What is the treatment?

The use of intravenous antibiotics in labour has been shown to be effective in the
prevention of newborn GBS infections. These antibiotics (normally penicillin) must
be given every four hours from the start of labour until the baby is born, in women
who have any of the above mentioned risk factors. At least 4 hours of antibiotic cover
before the birth is desirable.
Are there any risks with antibiotics?

There are risks associated with the use of any drug. Some women have a specific
allergy to antibiotics. This may include death or injury to a very few women from a
severe allergic reaction (anaphylaxis). Some women may experience temporary side
effects such as diarrhoea or nausea. However for most women antibiotics are safe.
It is therefore sensible to discuss antibiotic options with your healthcare provider to
ensure the most appropriate care for you and your baby.
NB—it is essential to inform your health professionals if you are

allergic to penicillin.
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What is the treatment for GBS infection in babies?

Babies with signs of GBS infection (see above) should be treated with antibiotics as
soon as possible. In most cases GBS infection can be treated successfully with antibiotic
therapy and intensive care. Most babies will make a full recovery. Unfortunately, even
with the best medical care, approximately 10% of babies who develop GBS infection
will die. Of the babies who contract GBS meningitis, up to half may suffer long-term
mental or physical problems.
Remember that most infections are preventable by using the treatment approaches
mentioned above for women who have risk factors for GBS disease. Babies who show
no signs of GBS infection and who are well do not normally need antibiotics. Some
babies born in higher risk situations, e.g. where the mother had a previous baby with
GBS infection, may need antibiotics even if they appear to be well.
In Portiuncula University Hospital these babies will be admitted to Special Care Baby
Unit after delivery for close observation and prophylactic therapy, as they are at
greater risk of developing GBS.
What infections can GBS cause in the mother?

GBS may also cause infections in the mother. These include: Infection of the
membranes and urinary tract infections antenatally or in labour. Breast infections,
uterine infections, wound infections and urinary tract infections in the postnatal
period.
Is there anything else I should know?

No screening test is entirely accurate. A screening test for GBS carriage could give a
falsely negative result. In other words a woman could be given a negative result when
in fact she carried GBS in her vagina. No treatment can be guaranteed to work all
the time for everyone. Even with antibiotic treatment in labour, some babies will still
develop GBS infection. It is recommended that you breastfeed your baby in the usual
way. Breastfeeding has not been shown to increase the risk of GBS infection and will
protect your baby against other infections.
If you have any questions about GBS or any other health concerns in your pregnancy,
please discuss with your Midwife, Obstetrician or GP.
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How to recognise GBS infection in babies?

Early onset GBS (EOGBS) presents soon after the birth with 90% of babies showing
signs of EOGBS infection within 12 hours of birth and the remainder within 6 days
after birth. It is the most common type of GBS infection accounting for 80% of GBS
cases in babies. Late onset GBS is much less common and occurs after 6 days of life.
Possible signs of GBS infection include:
• Grunting (noisy breathing) or fast breathing
• Abnormal drowsiness / sleepiness
• Poor feeding, vomiting
• Poor handling, irritability, high-pitched cry
• Tense, bulging fontanelle
• Unusual changes in behaviour, stiffness, extreme limpness,
• Seizures
• Pale, blotchy skin or rash
• High or low temperature
Remember to trust your instincts. If you are concerned that your baby is showing any
signs of infection, call your midwife (while in hospital) or GP (if at home) immediately.
If your GP is unavailable, go straight to the nearest Emergency Department. Early
diagnosis and treatment are essential, delay can be fatal.
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Sepsis in Pregnancy
Sepsis is a severe infection which affects the entire body, the first signs are usually a
rise in your temperature, heart rate and respirations, you may also feel unwell, have
chills and flu-type symptoms, abdominal pains and diarrhoea. This can progress very
quickly in rare circumstances to a potentially life threatening condition. Infection in
pregnancy and or after delivery should never be taken lightly; in rare circumstances
even when healthy, you can become critically ill very quickly from serious infection or
sepsis.
Timing of serious infections:

Sepsis in pregnancy most commonly occurs between December and April often
preceded by a sore throat or other upper respiratory tract infections. Sepsis may
happen in pregnancy or after your baby is born. The risk of getting an infection is
increased in the following circumstances:
Post delivery is the most common period for serious septic illness to develop; in
particular if,
• Your baby was delivered by caesarean section or by forceps / vacuum,
• If you had third degree tears, (large tears to your perineum)
• After having a miscarriage and or termination
• If you had a preterm birth
• If your waters are gone early and or gone for more than 24 hours.
• If you develop a urinary tract infection
However sepsis can occur in rare exceptions even when you are healthy have healthy
pregnancies and have a normal vaginal birth.
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How can sepsis in pregnancy be prevented:

Good personal hygiene, daily showers/ baths, proper hand washing and drying,
perineal hygiene to include keeping the perineal area clean, dry and frequent maternity
pad changes, these measures may prevent infection that could lead to sepsis.
Be aware of risk factors for infection as above. You should contact your G.P. or the
maternity unit immediately if feeling concerned, unwell and/or if you notice any of the
following during pregnancy or after your baby is born:
• Sore throat, chest infection
• Urinary tract infections, pain/ burning on passing urine
• Genital tract infection (vaginal/uterine infection) leading to vaginal discharge
which may be foul smelling and/ or an unusual change in colour
• Abdominal pain
• Sudden increase in vaginal bleeding postnatally
• Chills, flu type symptoms
• Diarrhoea
Completing any course of antibiotics that you are prescribed during pregnancy and
the post natal period, may also prevent more serious infection developing.
Cytomegalovirus (CMV)
A pregnant woman infected with CMV can pass the virus to her baby during pregnancy.
Most babies born with CMV infection will be fine and will not have symptoms or
develop health problems.
However, some babies will have permanent problems, such as hearing or vision loss
or mental disabilities, at birth, or develop problems later on.
CMV is passed from infected people to others through body fluids however, it does
not spread very easily. Infants and young children are more likely to shed CMV in their
saliva and urine.
If you’re pregnant or planning a pregnancy, the best way to protect your baby from
CMV is to protect yourself.
• Wash your hands often with soap and water especially after changing a nappy;
feeding, wiping a child’s nose or mouth, and touching their toys, pacifier, or other
objects.
• Don’t share food, drinks, eating utensils, or a toothbrush with a child.
• Do not put a child’s pacifier in your mouth.
• Use soap and water or a disinfectant to clean toys, countertops, and other
surfaces that may have a child’s saliva or urine on them.
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Hand Hygiene
Hand hygiene is one of the simplest and most effective ways to control the spread
of infections in hospitals and healthcare settings. However, handwashing is often
neglected or carried out poorly.
Hands will pick up germs (bacteria and viruses), and even though they may appear
to be clean, the germs will be there. Unfortunately we cannot see germs with the
naked eye. These germs can be easily removed by hand hygiene. Visitors to a
healthcare setting can bring infections into the healthcare setting without being
aware of it.
When to clean your hands

• Always clean your hands with soap and water before and after visiting the toilet
• After changing your sanitary pads.
• After changing your baby’s nappy
• Before eating or handling food.
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Pregnancy Complications
Pre-eclampsia
What is pre-eclampsia?
Pre-eclampsia is a condition which occurs only during pregnancy. It is diagnosed
when there is a higher than normal blood pressure reading and protein in the urine
sample. It is usually mild but sometimes it can become serious. Often there are no
symptoms and it may be picked up at your routine antenatal appointments when you
have your blood pressure checked and urine tested. This is why you are asked to bring
a urine sample to your appointments.
How it affects you and your baby

Around one in 200 women develop severe pre-eclampsia during pregnancy. The
symptoms tend to occur later in pregnancy but can occur for the first time only after
birth. Severe pre-eclampsia can be life threatening for both mother and baby.
The symptoms of severe pre-eclampsia include;

• Severe headache that doesn’t go away with simple painkillers
• Problems with vision, such as blurring or flashing before the eyes
• Severe pain just below the ribs
• Heartburn that doesn’t go away with antacids
• Rapidly increased swelling of the face, hands or feet
• Feeling very unwell
Pre-eclampsia may cause your baby to grow slowly because he or she cannot get
enough nutrients and oxygen from the placenta. There may also be less fluid around
your baby in the womb. If the placenta is severely affected, your baby may become
very unwell.
Who is at risk of pre-eclampsia and can it be prevented?

Pre-eclampsia can occur in any pregnancy but you are at higher risk if:
• Your blood pressure was high before you became pregnant
• Your blood pressure was high in a previous pregnancy
• You have a medical problem such as kidney problems or diabetes or a condition
that affects the immune system, such as lupus.
If any of these apply to you, you should be advised to take low-dose aspirin (75 mg)
once a day from 12 weeks of pregnancy, to reduce your risk.
47
The importance of other factors is less clear-cut, but you are more likely to develop
preeclampsia if more than one of the following applies:
• This is your first pregnancy
• You are aged 40 or over
• Your last pregnancy was more than 10 years ago
• You are very overweight – a BMI (body mass index) of 35 or more
• Your mother or sister had pre-eclampsia during pregnancy
• You are carrying more than one baby.
If you have more than one of these risk factors, you may also be advised to take low-
dose aspirin once a day from 12 weeks of pregnancy.
How is pre-eclampsia monitored?

Routine antenatal checks are important no matter how well you feel. Your blood
pressure will be checked against previous readings and your urine will be tested for
protein. A rise in blood pressure and protein in your urine can be an early warning sign
that pre-eclampsia is developing although you may be unaware that there is anything
wrong. Early diagnosis of pre-eclampsia is important so that your baby can be closely
monitored.
If you are diagnosed with pre-eclampsia, you should attend hospital for assessment.
While you are at the hospital, your blood pressure will be measured regularly and you
may be offered medication to help lower it. Your urine will be tested to measure the
amount of protein it contains and you will also have blood tests done. Your baby’s
heart rate will be monitored and you may have ultrasound scans to measure your
baby’s growth and wellbeing.
What happens if I develop severe pre-eclampsia?

If you develop severe pre-eclampsia, you will be cared for by a specialist team. The only
way to prevent serious complications is for your baby to be born. Each pregnancy is
unique and the exact timing will depend on your own particular situation. This should
be discussed with you. There may be enough time to induce your labour. In some
cases, the birth will need to be by caesarean section. Treatment includes medication
(either tablets or via a drip) to lower and control your blood pressure. You will also be
given medication to prevent eclamptic fits if your baby is expected to be born within
the next 24 hours or if you have experienced an eclamptic fit. You will be closely
monitored on the labour ward. In more serious cases, you may need to be admitted to
an intensive care or high dependency unit.
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What happens after the birth?

Pre-eclampsia usually goes away after birth. However, if you have severe pre-
eclampsia, complications may still occur within the first few days and so you will
continue to be monitored closely. You may need to continue taking medication
to lower your blood pressure. If your baby has been born early or is smaller than
expected, he or she may need to be monitored. There is no reason why you should
not breastfeed should you wish to do so. You may need to stay in hospital for several
days. When you go home, you will be advised on how often to get your blood pressure
checked and for how long to take your medication. You should have a follow-up with
your GP 6–8 weeks after birth for a final blood pressure and urine check. If you had
severe pre-eclampsia or eclampsia, you should have a postnatal appointment with
your obstetrician to discuss the condition and what happened. If you are still on
medication to treat your blood pressure 6 weeks after the birth, or there is still protein
in your urine on testing, you may be referred to a specialist.
Gestational Diabetes
Gestational Diabetes Gestational diabetes mellitus (GDM) is a type of diabetes that
occurs during pregnancy and usually goes away after the baby is born. It occurs in
12% of pregnancies in the west of Ireland. If you have diabetes, your body is not able
to control your sugar levels.
Gestational diabetes can affect your baby’s growth and can cause pregnancy
complications. However, diabetes can be treated and the risks reduced.
What are the symptoms?

Very often there are no symptoms. Some women might have increased thirst,
increased need to pass urine or increased hunger.
How does gestational diabetes affect the baby?

As glucose crosses the placenta, the baby is exposed to the mother’s high glucose
level and this can cause the baby to grow bigger and fatter. Untreated or uncontrolled
gestational diabetes can mean problems for your baby such as:
• Being born very large and with extra fat; this can make birth difficult and more
dangerous for the baby
• Low blood glucose after birth
• Breathing problems
• Requiring admission to a special care baby nursery.
When gestational diabetes is well controlled, these risks are greatly reduced
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What is an Oral Glucose Tolerance test (OGTT)?

This test is to find out if you have gestational diabetes. It is usually carried out around
24-28 weeks of your pregnancy but your doctor may decide you need it earlier.
Why do I need a Glucose Tolerance Test?

The following are some reasons why you might need this test:
• You had some sugar in your urine on two occasions or a large amount on one occasion.
• You previously delivered a large baby(over 4.5kg)
• Your body mass index (BMI) is 25-30kg/m2 or over.
• You have a family history of diabetes.
• You had a previous unexplained stillbirth.
• You belong to an ethnic minority – for example: South Asian, Afro Caribbean, African.
• You have polycystic ovarian syndrome.
• You are on long-term steroids.
• You have increased fluid around the baby (polyhydramnios)
• You have a history of thyroid disease or other endocrine disorder.
• You are on fertility treatment.
• You have coeliac disease or other autoimmune disorder.
• You are over 30 years of age
How is the test done?

You will be asked to:
• Eat and drink normally in the days before your test.
• Fast from 10pm the night before your test. You may drink sips of water only.
• You must not smoke or chew anything.
• The test takes 2-3 hours.
• It is important that you do not rush around prior to or when you are having your
OGTT.
• You must not eat, smoke or drink anything other than water during the OGTT.
If you do not follow this advice, the test will have to be repeated. We suggest you
bring some reading material to keep you occupied during the test and a snack to eat
after the test is completed.
Where is the test done?

The test is usually performed in the Outpatients Department. You must book into
reception on arrival.
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What will happen during the test?

A fasting blood sample will be taken from the vein on your arm. You will be asked to
drink a prepared glucose drink (polycal).
You will then rest for an hour after which a second blood sample will be taken.
The third final blood test will be taken one hour later. You may then eat and go home.
How is Gestational diabetes treated?

Special attention is paid to home blood glucose monitoring, diet and physical activity.
Sometimes medications may be needed.
When will I get the results?

The results take a few days to process. If they are normal, you will be informed of the
results at your next antenatal visit. If the results are abnormal, you will be contacted
by a midwife or medical doctor who will refer you to the Combined Diabetes and
Antenatal Clinic. If you have this test done with your GP, and the results are abnormal,
he or she will refer you directly to the Combined Diabetes and Antenatal Clinic. You
will meet diabetes doctors and nurses that specialise in diabetes who will advise you
on how to manage this condition.
What happens to me after my baby is born?

Gestational Diabetes will usually disappear after you have your baby. A follow up
oral glucose tolerance test will be arranged for you in PUH around 12 weeks after
you have had your baby. Having had gestational diabetes during this pregnancy puts
you at higher risk of developing gestational diabetes in future pregnancies. Half of
the women with gestational diabetes will go on to develop Type 2 diabetes within
5 years unless they make lifestyle changes. It is important that you are checked for
diabetes every year as Type 2 diabetes can develop slowly and you may not have any
symptoms.
You can reduce your risk of gestational diabetes in future pregnancies or developing
Type 2 diabetes by reaching a healthy weight for your height. The best way to do
this is to watch your dietary intake, your physical activity level and monitor your
weight. Exercise at least 30 minutes, five days a week. Make healthy food choices of
fresh fruits and vegetables and whole grain breads/cereals. Breastfeeding your baby
can also help you lose pregnancy weight. Breastfeeding has been shown to reduce
childhood obesity as well as having nutritional and immunological advantages.
Should you find yourself pregnant, it is vital that you have your blood glucose checked
as soon as possible and book an immediate antenatal check-up. Further information
is available on info@diabetes.ie
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Deep Venous Thrombosis

Reducing the risk of venous thrombosis in pregnancy and after birth
What is venous thrombosis?
A thrombosis is a blood clot in a blood vessel (a vein or an artery). Venous thrombosis
occurs in a vein. Veins are the blood vessels that take blood back to the heart and
lungs whereas arteries take the blood away. A deep vein thrombosis (DVT) is a blood
clot that forms in a deep vein of the leg, calf or pelvis.
How common is it in pregnancy?

Pregnancy increases your risk of a DVT, with the highest risk being just after you have
had your baby. However, venous thrombosis is still uncommon in pregnancy or in the
first 6 weeks after birth, occurring in only 1–2 in 1000 women. A DVT can occur at any
time during your pregnancy, including the first 3 months, so it is important to see your
midwife early in pregnancy.
Why is a DVT serious?

Venous thrombosis can be serious because the blood clot may break off and travel in
the bloodstream until it gets lodged in another part of the body, such as the lung. This
is called a pulmonary embolism (PE) and can be life threatening. However, dying from
a PE is very rare in women who are pregnant or who have just had a baby.
The symptoms of a PE can include:
• Sudden unexplained difficulty in breathing
• Tightness in the chest or chest pain
• Coughing up blood (haemoptysis)
• Feeling very unwell or collapsing.
You should seek help immediately if you experience any of these symptoms.
Diagnosing and treating a DVT reduces the risk of developing a PE.
What increases my risk of DVT or PE?

Your risk of venous thrombosis is increased further if any of the following apply to you.
Before pregnancy If you:

• Are over 35 years of age
• Have already had three or more babies
• Have had a previous venous thrombosis { have a mother, father, brother or sister
who has had a venous thrombosis
• Have a thrombophilia (a condition that makes a blood clot more likely)
52
• Have a medical condition such as heart disease, lung disease or arthritis – your
doctor or midwife will be able to tell you whether any medical condition you have
increases your risk of a DVT/PE
• Have severe varicose veins that are painful or above the knee with redness/
swelling
• Are a wheelchair user.
Lifestyle If you:
• Are overweight with a body mass index (BMI) over 30,
• Are a smoker or if you use intravenous drugs.
During pregnancy If you:

• Are admitted to hospital
• Are carrying more than one baby (multiple pregnancy)
• Become dehydrated or less mobile in pregnancy due to, for example, vomiting in
early pregnancy
• Being in hospital with a severe infection such as appendicitis or a kidney infection
or if you are unwell from fertility treatment (ovarian hyperstimulation syndrome)
• Are immobile for long periods of time, for example after an operation or when
travelling for 4 hours or longer (by air, car or train)
• Have pre-eclampsia
After the birth of your baby If you:

Have a very long labour (more than 24 hours) or have had a caesarean section, lose a
lot of blood after you have had your baby or receive a blood transfusion.
53
When will my risk be assessed?

Before pregnancy
If you have any of the risk factors listed above and are planning a pregnancy you
should talk to your GP or midwife. You may need to see an obstetrician early in
pregnancy to discuss starting treatment. If you have previously had a DVT or PE or
have a thrombophilia (see above), your GP can arrange a hospital appointment with a
doctor who specialises in thrombosis in pregnancy. If you are already taking warfarin
to treat or prevent venous thrombosis, you may be advised to change to heparin
injections because warfarin can be harmful to your unborn baby (see section below).
Most women are advised to change before becoming pregnant or as early as possible
in pregnancy. For some women, warfarin may be the only option. Talk to your doctor
before you become pregnant so that any changes can be planned to keep you and
your baby as healthy as possible.
During and after pregnancy
Your midwife should carry out a risk assessment at your first antenatal booking.
A risk assessment should also be carried out if your situation changes during your
pregnancy and/or if you are admitted to hospital.
After your baby is born a further risk assessment should be done.
How can I reduce my risk of getting a DVT or PE?

You can reduce your risk of getting of a DVT or PE:
• Stay as active as you can
• Wear special stockings (graduated elastic compression stockings) to help
prevent blood clots
• Keep hydrated by drinking normal amounts of fluids
• Stop smoking
• Lose weight before pregnancy if you are overweight.
You may be advised to start treatment with injections of heparin, which is an
anticoagulant used to thin the blood. There are various types of heparin. The most
commonly used in pregnancy is low-molecular weight heparin (LMWH). Heparin
is also used to treat venous thrombosis, but the dose of heparin used to prevent a
venous thrombosis is usually less. For most women, the benefits of heparin are that it
reduces the risk of a venous thrombosis or a PE developing.
Are there any risks to my baby and me from heparin?

Low-molecular-weight heparin does not cross the placenta and therefore cannot
harm your baby. There may be some bruising where you inject – this will usually fade
in a few days. One or two women in every 100 (1–2%) will have an allergic reaction.
If you notice a rash after injecting, you should inform your doctor so that the type of
heparin can be changed.
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How long will I need to take heparin?

The length of time you will be advised to stay on heparin depends on your risk factors
and whether your situation changes. Sometimes, treatment may be recommended for
the whole of your pregnancy and for up to 6 weeks after the birth.
What should I do when labour starts?

If you think you are going into labour, do not have any more injections. Phone your
maternity unit and tell them that you are on heparin treatment. They will advise you
what to do.
If the plan is to induce labour, you should stop your injections 12 hours (24 hours if
you are on a high dose) before the planned date.
What happens if I have a caesarean section?

If you are having a planned caesarean section, your last heparin injection should be
12 hours (24 hours if you are on a high dose) before the planned caesarean delivery.
Heparin will usually be restarted within 6 hours of the operation.
What happens after birth?

It is important to be as mobile as possible after you have had your baby and to avoid
becoming dehydrated. A risk assessment will be carried out after the birth of your
baby. Even if you weren’t having injections in pregnancy, you may need to start
heparin injections for the first time after birth. This will depend on what risk factors
you have for a DVT. You may be advised to have heparin for 7–10 days after birth or
sometimes for 6 weeks after birth. If you were on heparin before the baby’s birth, you
are likely to be advised to continue this for 6 weeks afterwards. If you were taking
warfarin before pregnancy and have changed to heparin during pregnancy, you can
change back to warfarin usually 3 days after birth. At your postnatal appointment,
your doctor should:
• discuss future pregnancies – you may be recommended heparin treatment during
and after your next pregnancy but if, for example, you stop smoking or lose weight
before your next pregnancy, heparin treatment may not be necessary next time
• discuss your options for contraception – you may be advised not to use any
contraception that contains oestrogen, such as the ‘combined pill’, as this can
also add to your risk of DVT.
Can I breastfeed?
Yes – both heparin and warfarin are safe to take when breastfeeding.
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Getting ready for birth

Antenatal classes should form an integral part of your preparation for birth.
Information is empowering: Good preparation will give you confidence in your
ability to cope well with labour, the birth of your baby, feeding and caring for
your baby in the early days. We offer you a choice of classes:
1. Early Pregnancy Class (from 16-20 weeks pregnant)

2. Antenatal Preparation classes
3. Hypnobirthing-Antenatal preparation Classes
4. A Breastfeeding Workshop is available to all pregnant women
regardless of whether they attend antenatal class or not.
5. Birth after Caesarean.
Please discuss your options with a midwife at your antenatal appointment.

Early booking is advisable as places are limited.
Antenatal Preparation Class.

Antenatal preparation consists of two classes held on two separate afternoons.
Each class lasts two hours and provides you with information on
• Changes to your body during pregnancy
• What to bring to hospital with you
• When to come to the hospital
• Signs of labour
• Stages of labour
• Breathing and relaxation, and methods of pain relief
• Role of your birth partner
• Caring for your baby in the very early days.
You may attend on your own or bring your birth partner. To book your place on
this course, please inform your midwife at your first booking antenatal visit.
These classes are free of charge.
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Hypnobirthing - Antenatal
Preparation Class
Hypnobirthing is a method that helps you develop a sense of deep
relaxation, reducing the effects of fear and tension that can lead to pain
and prevent your body from birthing normally. During the Hypnobirthing-
Antenatal preparation course you will learn techniques which can help you
towards a calmer labour and birth, these include;
• Practical techniques for self hypnosis, breathing and relaxation.

• How to overcome anxiety and fear.
• Massage techniques.
• To understand how your body works to birth your baby.
• Help partners understand the importance of their role.
The course is taught over 4 sessions, with each session lasting 3 hours. The
ideal time to book a place on this course is when you are between 24 and
32 weeks pregnant.
The classes are taught by experienced midwives who are Hypnobirthing
practitioners.
For more information about this course please speak to one of the midwives
at your next antenatal visit. There is small nominal charge to cover the cost
of Hypnobirthing Book and MP3 tracks.
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Breastfeeding Workshop:
for Pregnant women and their Partner
The ideal time to attend is when you are between 30 and 36 pregnant. We
encourage partners to attend, but you may attend on your own or bring a
friend.
This 1.5 hour class will cover:
• The magical first hour – the importance of having your baby in skin to skin
contact.
• The importance of early and frequent breastfeeding
• The importance of expressing your milk if your baby is not yet ready for feeds,
for example if your baby is born very early.
• How to breastfeed twins.
• How to get off to a good start.
• How to know that your baby is getting enough milk.
• How to avoid colic.
• Partners learn how they can help and support you and how they become
involved with baby care.
• How to rest and care for yourself.
• How to avoid cracked nipples, blocked ducts and mastitis.
• Where to get breastfeeding support – and what breastfeeding support we offer
you.
To book your place phone 090 96 24619: leave your name and number on
voice mail and we will call you back. There is no charge for the breastfeeding
workshop.
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Birth After Caesarean Section
After listening to women speak about birth experiences, midwives and obstetricians
have come to realise that whatever way a baby is born women who are actively
involved in the planning of their baby’s birth, report a better birth experience. It is very
rare for mothers to die (approx. 1 woman dies out of every 25,000 having a baby in
Ireland). However, the death rate is 3-4 times higher for women who decide to have
an elective repeat Caesarean Section (ERCS), compared to women who plan to have
a Vaginal Birth after Caesarean (VBAC). The maternity staff wants to support you in
making decisions around your next birth after a previous caesarean section.
Please speak to a midwife in the clinic if you are interested in attending specific
one to one education regarding type of birth after a caesarean section birth.
When you next become pregnant and book into Portiuncula university
Hospital, you will be offered referral to the ‘Birth after Caesarean clinic (BAC).
At this clinic, you will be seen by a senior midwife between 24 and 28 weeks
and be given the opportunity for one to one structured antenatal education
and support to, inform and support you in making an informed decision
around your subsequent mode of birth.
During this session the midwife will discuss with you,

• Your previous birth experience and indications for caesarean delivery
• The risks and benefits of VBAC and ERCS as they relate to your circumstances
• A pathway of care for your forthcoming birth. 59
Successful Vaginal Birth after Caesarean Section (VBAC)

• Three out of 4 women who had a Caesarean section before, with a normal,
healthy pregnancy who start labour naturally will give birth vaginally.
• Nine out of 10 women who had a Caesarean section before (90%) will give birth
vaginally if they had a vaginal birth before, either before or after their CS.
• VBAC allows for a greater chance of having an uncomplicated normal birth in
future pregnancies.
• VBAC usually results in less pain after birth, quicker recovery and a shorter stay
in hospital.
• Vaginal birth is associated with increased breast feeding rates and fewer
problems adapting to motherhood.
• Women describe VBAC as a more emotional, positive and empowering
experience than repeat Caesarean section.
If you require further information Please speak to a midwife or your doctor.
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Packing your
Hospital Bag
What you need to bring with you for your stay at
Portiuncula University Hospital:
Mother
• Three or more cotton nightdresses or pyjamas (preferably light and made of
cotton). Try and purchase nightwear that has nursing clips or that can be pulled
down easily, if you are planning on breastfeeding.
• An old nightdress or t-shirt for labour.
• Four large packs maternity sanitary towels.
• Disposable/or large panties.
• Nursing Bras: If you are planning on breastfeeding, pack some nursing bras so it
is easier for yourself and your new arrival.
• Breast pads.
• Dressing gown, flip flops for shower.
• Slippers, old pair of socks for labour
• Towels: Two large and one small in a dark colour.
• Toiletries: Shampoo, conditioner, shower gel, moisturiser, deodorant, toothbrush
and tooth paste, lip balm and face wipes.
• Hair Accessories: Hair brush, head bands, bobbins, pins and a travel hair dryer.
• Phone charger.
• Pack an outfit that you can wear home from the hospital. Again, the comfier the
better.
Baby
• Four baby vests.
• Six babygros and bibs.
• Muslin cloths’
• Baby hats and cardigans.
• Baby cellular blankets & cot sheets.
• Baby towels for washing baby.
• 24 disposable nappies (extra will be required if baby is admitted to the Special
Care Baby Unit).
• One roll cotton wool, baby sponge.
• Baby water wipes or baby cleansing lotion.
• Vaseline or Sudocrem.
• Blanket and hat for going home.
• Baby seat for car journey home. 61
Labour and Birth

Signs of Labour
Every woman’s experience of labour is different.
You may only be able to work out when labour
truly started after you’ve been through it!
However, changes that take place in pre-labour
and early labour may cause tell-tale signs and
symptoms that labour is imminent.
In pre-labour or early labour (the latent phase), you may have:

• Persistent lower back pain or abdominal pain, with a pre-menstrual feeling and
cramps.
• Painful contractions or tightenings that may be irregular in strength and
frequency, and may stop and start.
• Broken waters. Your membranes may rupture with a gush or a trickle of
amniotic fluid. Although this can happen long before labour starts, you should
still call your maternity unit to let them know.
• A brownish or blood-tinged mucus discharge (bloody show). If you pass the
mucus plug that blocks the cervix, labour could start soon, or in a few days. It is a
sign that things are moving along.
• An upset tummy or loose bowels.
• A period of feeling emotional, excited or moody. You may feel restless, anxious
or impatient.
• Disrupted sleep.
As there can be an overlap between pre-labour and the start of labour itself, it’s
possible to confuse the symptoms of the two. How you’ll feel in the pre-labour or
early labour phases depends on:
• Whether you’ve had a baby before.

• How you perceive and respond to pain.
• How prepared you are for what going into labour may be like.
62
Can I tell if labour is about to happen soon?

Signs that the birth may be on its way include:
• Lightening, When your baby’s head drops into an engaged position in your pelvis.
You may be able to breathe more deeply and eat more, but you’ll also need to
pass urine more frequently, and walking may be more difficult.
• Heavier vaginal discharge with more mucus.
• More intense Braxton Hicks contractions.
• Mood swings.
What should I do in early labour?

The early phase of the first stage of labour is when your cervix dilates to 4cm. The
best thing to do during this time will depend on what time of day it is, what you like
doing, and how you’re feeling.
Keeping calm and relaxed can help you to cope with the contractions or tightenings.
It will also help your body to release the hormone oxytocin, which you need for your
labour to progress.

This could mean watching your favourite film, going for a walk, pottering around at
home, or asking a friend or relative over to keep you company. You could alternate
between walking and resting, or try taking a warm bath or shower to ease any aches
and pains. If you can, try to get some rest to prepare you for the work ahead.
During early labour, you may feel hungry, so eat and drink if you feel like it. Nibble on
small amounts of high-energy foods to keep you going. This will help to comfort you
and may even help your labour to progress more smoothly.
Early labour is a good time to try out different positions, breathing techniques and
visualisations to see if they help you to cope with contractions. If you have a TENS
machine, early labour is the time to use it. It’s unlikely to help if you wait until you’re
in active labour before you start using it.
How will I know when I’ve moved into active labour?

This is where your cervix dilates from 4cm to 10cm. For many women, the main sign is
painful, regular contractions/surges. These gradually become more frequent, longer,
and stronger in intensity. Your midwife may have told you what to expect, such as
contractions/surges coming at least every five minutes and lasting at least a minute.
However, for some women, labour progresses well without following a “textbook”
pattern.
63
Listen to your body and watch out for how you’re feeling. As labour intensifies, you’re
likely to talk less. You’ll find holding a conversation during a contraction/surge more
difficult. You may notice that you have to pause as each contraction/surge builds,
leaning forward and rocking your pelvis to help you through it.
As your labour progresses, you may start to turn your awareness inward, focusing
in on each contraction and using your breath to help you to cope. You might start
“sighing” out from the start of each contraction.
As your labour gets stronger, your appetite is likely to wane, and you may feel hot
and anxious. You may also start to feel less inhibited and care less about what you’re
doing. This may help you to demand exactly what you need to help you cope!
When should I go into Portiuncula University Hospital?

If you feel unsure about when you should go into hospital, telephone us for advice on
0909648250.
If your waters have gone, we will tell you to come in to be checked. If it is your first
baby and you are having contractions but your waters have not broken, we may ask
you to wait at home until your contractions are, regular, strong, about 5 minutes apart
and lasting about 45-60 seconds.
If you don’t live near the hospital, you may need to come in before you get to this
stage. Second babies often arrive more quickly than the first, so you may need to
contact the hospital sooner.
Remember to telephone the labour ward before leaving home.
What colour should my waters be?

Amniotic fluid is almost 99 per cent water so it’s normally clear with a yellow tinge or
sometimes a pink tinge.
If you’re close to or past your due date, your water may contain some of your baby’s
first poo (meconium). This may result in the waters having a green tinge to them, or
you may be able to see green or brown meconium . If this is the case your baby will
require close monitoring in labour.
Can I have contractions and not be in labour?

Yes. You can have pre-labour contractions (Braxton Hicks). These help your cervix
to go through the changes it needs to before it starts to dilate. Your cervix usually
points towards your back, but as you start to dilate it will move forward. It will also be
64 getting shorter and thinner (softening and effacing). These changes may take place
over the last few weeks of your pregnancy without you noticing. Alternatively, you
may experience hours or days of cramps or contractions. These may be helping the
early changes in your cervix to progress, even though they may not be dilating your
cervix yet.
Your midwife will advise you about ways to cope at home until labour becomes strong.
You should contact Portiuncula University Hospital at any time if:

• Your baby’s moving less than usual
• Your waters break, or you suspect you’re leaking amniotic fluid, so that you and
your baby can be checked over.
• You have vaginal bleeding (unless it’s just a small amount after a membrane
sweep or the blood-tinged mucus of the show).
• You have a severe headache, changes in your vision, or sudden swelling of the
face, hands or feet.
65
Stages of Labour
Before labour begins you may have contractions
that do not settle into a pattern. These may be
painful and could start several days before labour
begins. Once labour is fully established it is
completed for most women within 12 to 24 hours.
Labour can be divided into three stages:
The first stage of labour begins with regular

contractions of the uterus (womb) to soften and
open the cervix (neck of, or exit from, the womb).
Lasting 12 to 18 hours, this stage ends when the
cervix is open wide enough for your baby to move
down into your vagina (birth canal). The second stage is the pushing or emerging part
of labour. Your baby travels down your vagina and out into the world. This lasts up to
about two hours for a first baby. The third stage of labour comes after your baby has
been born. The placenta (afterbirth) and membranes come away from the uterus wall
and come out through your vagina.
First stage fo labour

Your contractions become stronger and more frequent, maybe lasting 20 to 40
seconds every 5 to 10 minutes.
When you arrive in Portiuncula,

the midwife in the labour ward
will take a history from you
and check your temperature,
pulse and blood pressure and
do a urine test. She will palpate
(feel) your tummy to check
the position of your baby and
listen to your baby’s heartbeat.
This can be done with a hand-
held stethoscope (Pinard) or
sonicaid.
As the contractions get stronger, the cervix may open more rapidly. Upright, forward-
leaning or kneeling positions tend to be more efficient and can ease pain. There is
evidence to show that remaining upright means less need for pain relief, and a shorter
first stage in labour. Breathing slowly can help release tension, so sigh out slowly
66 (SOS) through a relaxed, open mouth. Sipping water will help keep your mouth moist.
Try different positions to find what’s most comfortable for you.
Transition from first to second stage

Your contractions are changing from dilating the cervix to pushing your baby out.
Contractions may now be very strong and close together.You may feel irritable, angry,
hot or cold. You may cry, shake or vomit. All reactions are normal, although they can
be distressing. You may start making a lot of noise. You may feel most comfortable
sitting on the toilet.
Second stage
The second stage of labour (also called ‘the pushing stage’) starts when the cervix
is fully open and ends when your baby is born. At this stage your baby is moving
from your uterus into your vagina, as the baby’s head descends further through the
birth canal, the contractions get stronger and so does the urge to push, if you have
an epidural you won’t be fully aware of these sensations. After every five minutes
the midwife will listen to your baby’s heart rate. The second stage can last from 10
minutes to two hours. Contractions during this stage may be several minutes apart.
The birth
As you give birth to your baby you will feel a lot of pressure on your bowels, and
stretching with a burning sensation around your vagina. As your baby’s head moves
down to the vaginal opening, the baby’s head will become visible. At a certain stage,
the midwife will tell you to either stop pushing, to push very gently or to pant.
Panting can slow down the stretching as the baby is born and prevent a tear. When
asked not to push, lift your head and pant, relax mouth, pelvic floor and legs. (If your
mouth is relaxed, your vagina will be too.)
Although it is very hard to move at this stage, a change of position may help your baby
to be born. If you want to you can reach down and touch your baby’s head.
Third stage
The third stage is the final stage of labour, during which the placenta (or afterbirth) is
delivered. The birth of the placenta can be medically managed. This means we give
you an injection containing a drug called Oxytocin in your thigh or leg to speed up the
delivery of your placenta. Oxytocin helps the womb contract and expel the placenta
and help prevent heavy bleeding.
67
If you are not bleeding and wish to have a natural third stage (this is when you deliver
the placenta without the help of drugs) please discuss with your midwife. A natural
third stage can take longer, upright positions, skin to skin contact with baby and
starting to breastfeed, may all help to stimulate contractions.
Any tear or episiotomy (a surgical cut to the perineum – the muscle between your
vagina and back passage) will be stitched under local anaesthetic/epidural once the
placenta has been delivered
68
Pain relief in labour

Continuous One–to–One Support in Labour
Continuous one-to-one support from an experienced
birth professional has been shown to reduce women’s
need for pain relief in labour, increase their chances
of having a normal delivery and increase their level
of satisfaction with their childbirth experience. In
Portiuncula University hospital, you will be provided
with one-to-one care from a midwife throughout
labour.
Women may also choose to hire the services of a

Doula. This is a private arrangement between the
woman and the Doula. A doula is a woman who has
been trained to provide a continuous presence and
emotional support for women during labour. They
may also be trained to provide pain-relieving or coping methods that are non-drug
based, for example massage and touch, positive thinking and relaxation techniques.
Comfort Measures
Comfort measures are a number of different
approaches that can help you to cope with the pain
of labour. These may include; the application of hot
compresses using complimentary therapies, adopting
different positions in labour, the use of massage or
touch and also the use of comfort aids such as bean
bags or birthing balls.
Many women find these measures effective in easing

pain, helping aid relaxation and giving a sense of well-
being with no, or very little, potential to do harm.
Most of these measures are taught as part of the
hospital run antenatal classes and your labour ward
Midwife will support and advise you.
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Cognitive Strategies and Hypnosis

These are approaches that use positive thinking and an understanding of the labour
and birth processes to help women feel in more control of a given situation. There are
distinct strategies that can be used including:-
• Visualization, meditation
• Positive affirmations (e.g. my body is strong and is working well for me)
• Conscious relaxation of tense muscles
• Breathing techniques
• Non-focused awareness (i.e. notice what you see, hear, feel, smell without
holding on to any of them)
• Vocalizing, sounding or repeating a mantra
• Hypnosis; state of deep physical relaxation, is thought to inhibit the bodies stress
response and promote a positive approach to the pain of uterine contractions
It is important to note that the majority of these techniques require pre-labour

preparation, tuition and practice before they can be used effectively as a form of
pain relief during labour. Some of these techniques are taught at the antenatal and
hypnobirthing classes that are run in the hospital, but most are available through
private classes e.g. yoga, pregnancy pilates.
Transcutaneous Electrical Nerve Stimulation (TENS)

Transcutaneous electrical nerve stimulation (TENS) is a non pharmacological method
for relieving pain. TENS is widely used to manage chronic and acute pain. TENS has
been used to relieve pain in childbirth since the 1970s.
Benefits of using TENS in labour
• TENS is a form of non-invasive pain relief.
• TENS has no harmful effects on either mother or baby.
• TENS does not restrict your ability to move about in labour.
• TENS can be applied at home during early labour.
• As TENS is completely drug free it may also be used in conjunction. with other
forms of pain relief.
In order to manage your pain more effectively it is important to use TENS as early
in labour as possible. TENS is more effective if you use it in combination with other
coping strategies such as relaxation, positioning and massage. The TENS electrodes
need to be positioned over the nerve pathways which transmit pain messages from
70 the uterus and cervix during labour.
Initially, you may wish to start with the Channel 2 electrodes placed either side of the
spine just above the waist (see diagram).
As your labour progresses or if you are experiencing lower back or pelvic pain you can
start using the Channel 1 electrodes which are placed either side of the lower spine
below the waist (see diagram). The Channel 1 and Channel 2 electrodes can be used
simultaneously.
How does Tens Work?

The TENS unit produces tiny electrical impulses which are sent through the skin to
the nerves. When using TENS, women experience a tingling or buzzing feeling at
the site of the electrodes. The feeling is very similar to the tummy toning machines
available.
When we experience pain, messages are sent along the nerves to the brain and then
pain is felt. This electrical stimulation of the nerves by the TENS machine blocks
those pain messages from reaching the brain. The brain then registers the tingling
sensation produced by the TENS unit rather than the pain. TENS also increases your
body’s production of endorphins – these are your body’s natural painkillers.
It takes on average 20-40 minutes of using stimulation before these endorphins are
released. The body will continue to release these until the treatment has stopped.
The endorphins also remain in the body for several hours after the stimulation has
stopped, giving residual pain relief 71
Why use the trigger facility?

When the intensity is increased the stimulation causes the endorphins to be released
throughout the body. As labour progresses and the contractions become stronger it is
suggested that you use the trigger facility to maximise your pain management when
your contractions occur. When the trigger button is pressed it automatically changes
the stimulation to continuous pain blocking and increases the output significantly,
delivering maximum pain relief when you require it most. Once the contraction is
over, press the trigger button again to return to endorphin release stimulation.
Precautions when using TENS

TENS is an electricity-based apparatus and therefore care must be taken when using
it. Specific precautions include:
• TENS should not be used in the bath or in the shower.
• Women who have metallic implants or an implanted electronic device, (e.g. a
cardiac pacemaker) should not use TENS.
• TENS should not be used whilst driving a car.
• TENS should not be used prior to the 37th week of your pregnancy unless advised
by your doctor or physiotherapist.
• TENS must be turned off before applying or removing the electrodes.
• TENS should be kept out of reach of children.
Where can I obtain a TENS machine?

TENS machines are widely available on the internet and if you decide to purchase one
over the internet it is important you buy one specifically for labour as these machines
will also have boost button functionality. This boost button will increase the sensation
during the contraction and revert to lower levels following the contraction.
Machines are also available to rent / purchase from many places and sites, including
Boots, Medicare www.medicare.ie or BMR Neurotech www.bmr.com (1800 511 511).
or www.gmmedicalsolutions.co.uk Tel: (01) 6190626
72
Entonox (gas and air)

This is inhaled through a mask or
mouthpiece, it takes about 10 seconds
to work, reduces the intensity of your
pain and lasts for about a minute. Hold
the mouthpiece, take three or four deep
breaths as soon as the contraction
starts, put the mouthpiece down, then,
using movement, massage or distraction
techniques, work with the rest of the
contraction. Avoid using Entonox
throughout the contraction as this may
make you feel very lightheaded.
Advantages
• It is available instantly
• It can be used whenever you decide you need it. You are in control and give the
gas to yourself.
• It works within 30-40 seconds but has no lasting effect. Once you stop using it
the effects wear off rapidly.
• It can be used throughout labour without affecting contractions or the progress
of your labour.
• It has no known ill effects on the health or well-being of the baby.
Disadvantages
It does not lessen the pain of the contractions, but just helps to relax you.
• It is sometimes difficult to get the timing right. If you start inhaling the entonox
too late in relation to the contractions, it may not be fully effective by the time the
contraction is at its strongest. This may improve with practice and your midwife
will advise you on how best to use it.
• Some women may notice some unhelpful side effects. These include feeling sick,
drowsy, dizzy or lightheaded. Therefore it may limit how much you may move
around during labour.
• It may make your mouth dry, so ask for a drink in between contractions.
• It can affect your ability to remember events around your labour and the baby’s
birth.
73
Pethidine
Pethidine is a drug which is given as an injection into your thigh or buttock. It works
by decreasing the sensation of pain. Research has shown that it is much less effective
than an epidural at relieving pain in labour.
Advantages
• It can be given within 5 minutes of asking for it. It usually works within
approximately 20 minutes and the effects tend to last for at least a couple of
hours.
• Providing you are having regular and strong contractions (in established labour)
it should not slow down contractions or progress in labour.
• It can help you to relax which may allow you to rest. This may also help labour
progress more quickly.
Disadvantages
• It may make you feel sick or “woozy” (you will be given a drug at the same time
which prevents sickness)
• It may make you feel light-headed, which may prevent you from moving around
during labour.
• If given too close to the time of birth, it may also make the baby sleepy and effect
their breathing (your baby may need an injection to reverse this effect).
• The baby may be sleepy in the first few days and it may make breastfeeding
harder to establish.
Epidural
The epidural is an anaesthetic injected
into your back. A local anaesthetic is
injected through a narrow tube into
the epidural space. This numbs the
nerves from the uterus, abdomen and
lower back and takes away painful
sensations from the waist down. Your
blood pressure, your contractions and
your baby’s heartbeat will be monitored
during and after this procedure.
74
Advantages of Epidural
These are the main advantages of having an epidural during childbirth:
• It provides complete pain relief without making you feel confused or drowsy.
• It can be topped up if you need surgery (a Caesarean).
• It can allow you to have a rest, giving you more energy for pushing during the
final stage of the birth.
Disadvantages of Epidural
Epidural anaesthesia is a safe and reliable method of pain relief but there can be some
side effects.
• Low blood pressure. Low blood pressure is treated with medication, or by giving
fluids through a drip. Your blood pressure will be regularly checked during the
procedure.
• Backache. After having an epidural some people experience back pain that
lasts for several weeks or months in the area where the injection was given.
This sometimes happens because the back muscles relax after the epidural
anaesthetic has been inserted. Backache is also experienced after childbirth by
many women who didn’t have an epidural.
• Inability to move your legs. Following an epidural, your legs will feel heavy.
This will only last until the anaesthetic wears off.
• Itchy skin. Some of the medication that is used for epidurals can cause itchiness.
Your healthcare professional will be able to change your medication in order to
deal with this.
• Uneven pain relief. Sometimes, the epidural anaesthetic doesn’t spread evenly
around your spinal cord, and you’ll have less feeling in one side of your body than
the other. A top-up dose can usually fix this.
• Vomiting sometimes happens after an epidural anaesthesia. However, there is
less chance of vomiting than there is after a general anaesthetic.
• Loss of bladder control. After an epidural, you can’t usually tell whether you need
to pass urine so you’ll have a catheter (a thin tube) inserted into your bladder so
that your bladder can drain when it’s full.
• No urge to push. If you have an epidural during labour, the final stage of labour
can take longer if you’re unable to feel your contractions. There is no need to
worry if you can’t feel the contractions as your midwife will tell you when to push.
75
• Medical intervention. If you have an epidural during labour, you will need medical
intervention. This is important because your baby’s heart rate and your blood
pressure will need to be monitored throughout the procedure in order to make
sure that you are both doing well.
• Assisted birth. With an epidural, there is an increased chance that you will need
to have an assisted birth using a ventouse suction cap or forceps. If assistance is
needed, your midwife will discuss this with you.
• You may have an ‘inactive’ birth. If you have an epidural, moving around can
sometimes be very difficult, or impossible. You will require assistance from your
midwife, or birthing partner. You may be unable to give birth in the position you
had planned to.
Rare epidural side effects

• Severe headache. Occasionally, during epidural anaesthesia, there is a small leak
of fluid from the spinal cord that causes a severe headache. This can last for a
week (or sometimes longer) and you may need to remain lying down until the
puncture has healed.
• Infection. Following an epidural, an infection can sometimes occur at the site of
the injection. However, this is unlikely because the needle is sterile and your skin
is cleaned thoroughly before the procedure is carried out.
76
Induction of Labour
Induction (starting labour off artificially) is offered to all women who don’t go into
labour naturally by 42 weeks, as there is a higher risk of stillbirth or problems for the
baby if you go over 42 weeks pregnant.
• If you don’t want to be induced, and your pregnancy continues to 42 weeks or
beyond, you and your baby will be monitored. Your obstetrician will check that
both you and your baby are healthy by offering ultrasound scans and checking
your baby’s heartbeat and liquor volume (fluid around the baby) and the
placenta’s functioning. If your obstetrician is concerned about the baby, they will
suggest that labour is induced.
• You may also be offered an induction if your waters have broken more than 24hrs
and labour has not started.
• If your baby is not growing as well as expected
• If you have any medical conditions such as pre-eclampsia, diabetes
What happens on the day of induction of labour?

If you require induction of labour, you will be given a date and a time to be admitted
to Portiuncula University Hospital. Once a bed is available, you will be admitted to
the Maternity Ward. (It is important to note that on some occasions there may be
a delay in bed availability, this is due to a very busy time in the unit). Before going
to maternity ward, please check-in at Admissions located in Accident & Emergency
which is situated on lower ground floor.
On morning of induction you will be brought to the labour ward and initial observations
are performed, for you and the baby. Then a vaginal examination will be performed to
help decide the most appropriate method of induction.
Membrane sweep
Although not a method of induction a ‘membrane sweep’ may be offered in the
antenatal clinic prior to induction. A ‘membrane sweep’ is a process where the
doctor performs a vaginal examination and makes a circular, sweeping movement
just inside your cervix to separate the membranes from the cervix. By performing a
membranes sweep, the chances of labour starting naturally within the following 48
hours can be increased. The procedure may cause some discomfort and afterwards
it is not uncommon to have a “show” later in the day. The “show” is a plug of mucous
(sometimes quite blood stained) which is released as the cervix begins to open. If you
are being induced for reasons other than being overdue a membrane sweep is less
likely to be performed.
Induction can be carried out in three ways. Some may need to be repeated or you may
need more than one before your labour begins.
77
Prostaglandin gel /Pessary tablet

Prostaglandin gel is used if the neck of the womb (cervix) is not soft (ripe). Before
you get the prostaglandin gel, the midwife will monitor your baby’s heartbeat using
a machine called cardiotocograph (CTG) for at least 20 minutes. The prostaglandin
gel is placed behind the cervix during an internal examination. This will help soften
the cervix and allow labour to progress as it would naturally. Once the gel has been
inserted the baby’s heartbeat is listened to and you have to lie on the bed at least
30mins. You will then be free to walk around as normal.
If you’ve had no contractions after six hours, you may have a further vaginal
examination. A second dose of prostaglandin may be required at this stage. In some
cases further doses of prostaglandin may be required the following day. If induction
of labour is not successful after 2 days you may be given a rest and induction process
restarted again.
Artificial Rupture of Membranes (ARM)

This is another name for breaking the waters. When your cervix is open enough, the
doctor/midwife will carry out a vaginal examination and break the waters using a small
plastic instrument called an amnihook to rupture (make a hole in) the membranes in
front of the baby’s head. This may be done without the need for prostaglandin if your
cervix is open enough at the first vaginal examination or it may be done after one
or more doses of prostaglandin have softened and opened your cervix. It only takes
a few minutes and can be a bit uncomfortable. Once the membranes are ruptured,
you may notice a gush or just a small trickle of the waters from around the baby
coming out vaginally. You may continue to notice leaking of the waters vaginally for
the rest of the labour. Your baby’s heartbeat will be monitored for 30 minutes after the
procedure. You will then be encouraged to walk around afterwards. The ARM may be
enough to encourage your uterus to start contracting.
Oxytocin
Oxytocin is a hormone that is released by your body when you start labour naturally
yourself. It causes contractions, which open your cervix and push the baby out. If your
labour is being induced you may be offered an artificial form of oxytocin known as
syntocinon. A small plastic tube (cannula) is put into your arm, using a needle, and
the syntocinon drip is connected to it. The contractions brought on by syntocinon
encourage dilatation of the cervix. The midwife will increase the rate of the drip
gradually until your contractions are regular and strong. You may ask for pain relief if
required. While you are on the oxytocin drip, your baby’s heartbeat will be monitored
continuously using a cardiotocograph (CTG).
78
What are the Risks associated with Induction of

Labour (IOL)?
Induction of labour may not alway be sucessful, if this happens to you the doctor will
discuss the options with you - one of which is Caesarean Section.
• The risk of failure for a first time mother is 1:4
• The risk of failure for subsequent pregnancies is 1:20
• Over-contracting of the womb may occur with either Prostaglandin or oxytocin;
drugs can be given to reverse over-contracting in extreme cases.
• Induction of labour may increase the possibility of an instrumental delivery
(vacuum or forceps).
The indications for an IOL will therefore be carefully considered and discussed with
you beforehand.
Is there anything you can do to help yourself?

Having an induction of labour may be uncomfortable for many reasons. But there are
things that you can do to make yourself more comfortable. Induction of labour can be
a long process so bring a book or some magazines, some music or anything that may
help pass the time or distract you.
Induction of labour with Prostaglandin can cause tightening of your uterus (womb)
that is not necessarily strong enough to put you into labour but which may be very
uncomfortable or painful. In these situations your midwife will encourage you to walk
around as much as possible. Walking around may help you to cope with any pain
and discomfort you are feeling. It helps to bring the baby’s head down and press on
the cervix, which may help stimulate the labour further and increase your chances of
going into labour. Other comfort measures include having a warm bath, or using
a TENS machine, a birthing ball, or relaxation techniques.
Pain relief and induction

You will be offered support and appropriate pain relief. This includes tablets, inhaled
gas known as Entonox and injections. Then, once you have gone into labour, you may
wish to request an epidural.
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Special Care Baby Unit (SCBU)
The Special Care baby unit is located on the first floor of Portiuncula University
hospital.
Why your baby may be admitted to the Special Care Baby Unit
Babies are admitted to the special care baby unit for a number of reasons. Many
are born preterm (born before 37 weeks gestation) and require careful observation
and monitoring. When term babies are admitted to the neonatal unit it may be
for observation following a complicated birth. Other conditions that necessitate
admission of term babies include rapid breathing after birth, known as transient
tachypnoea of the newborn (TTN), jaundice requiring phototherapy, poor feeding,
possible infection needing intravenous antibiotics, or if your baby needs support to
maintain their body temperature. Less commonly a baby may have a more serious
problem which requires investigation and a specific medical or surgical treatment, for
example, heart condition or intestine (bowel / gut) problem.
Very sick babies who require intensive support are transferred to a Level 3 Neonatal
Intensive Care in another hospital. Once the baby’s condition has stabilised, they are
transferred back to the special care baby unit in Portiuncula University Hospital.
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Family Centred Care

The philosophy of care provided in the special care baby unit is family- centred care.
Family-centred care is based on the understanding that the family is the baby’s
primary source of strength and support and that the family’s perspectives and
informed choices are important in clinical decision making. The staff will encourage
you to visit your baby frequently and be involved in their care.
Visiting Your Baby

Parents are welcome to visit their baby almost always but there are times when you
will be requested to leave the unit for a brief period, for example:
• During the daily ward round. This is necessary to protect the privacy and
confidentiality of other babies whose conditions are also being discussed.
• When there is an emergency or complicated procedure being performed.
• During shift change, when nurses are giving reports about the babies to the
incoming staff.
Infection Control
Hand hygiene is essential every time you visit the unit. Hand-washing is one of the
most effective ways of preventing infection and safeguarding your baby. If you are
visiting twins or triplets, please wash your hands before handling each baby. It is
important to wash your hands properly: first roll up your sleeves and remove any
watch, rings and bracelets; then wash your hands and lower arms in warm soapy
water; rinse your hands and lower arms in clean running water; and dry with a clean
towel. Alcohol gels and sanitiser can be used instead of hand-washing if your hands
are visibly clean.
For your baby’s safety, anyone who has been exposed to a contagious disease (for
example, chicken pox, German measles, tuberculosis) should not visit the neonatal
unit.
If you have a cold, fever or are ill in any way, please check with your baby’s doctor or
nursing staff before entering the unit.
We request that while you are in the unit you remain at your baby’s cot-side.
Telephone Contact number for SCBU is 090 9648283. At any time you are free to
phone the hospital to get the latest update and information from the nurse caring for
your baby.
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After the birth of your baby

Optimal Cord Clamping
In Portiuncula University Hospital, we practice optimal cord clamping. When you
have birthed your baby the midwife will dry your baby and if the umbilical cord is
sufficiently long she will place your baby directly onto your tummy with the umbilical
cord attached. When the umbilical cord ceases to pulsate (usually 1 to 3 minutes) she
will clamp the cord, allowing the blood in the placenta to transfuse into your baby.
When the cord is clamped, the midwife will then give your partner the opportunity to
cut the cord.
Benefits of Optimal Cord Clamping

• It supplies the baby with oxygen and nutrients
• It increases infant’s weight and improves blood pressure in the first hours after
birth.
• Babies who have had optimal cord clamping require fewer blood transfusions.
• It improves the iron status in your baby for up to six months after birth.
• It protects premature babies’ against organ damage, brain injury and death.
However, some studies did show that babies who have delayed cord clamping may
have a slightly increased incidence of jaundice.
Skin to Skin Contact

When your baby is born it will be delivered onto your abdomen and skin to skin
will begin. This helps your baby to adjust to life outside the womb and also helps
you breastfeed. Skin-to-skin care has been shown to help maintain the baby’s body
temperature, their heart rate, their blood sugar levels, and their respiratory rate and
also keep their blood pressure at a normal level. Mother and baby coordinate heart
rhythms to be within milliseconds of each other when the mother show signs of
affection. When babies are warm, they don’t need to use their energy to regulate
their body temperature, so they can use that energy to grow instead.
Studies show that babies who have skin-to-skin contact, particularly with their
mother, are less likely to cry than those separated from their mothers. If you or your
baby need medical care immediately after birth, we will help you start skin-to-skin
contact as soon as possible.
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To ensure that your baby enjoys safe skin-to-skin contact make sure that: your baby’s
chest is on your chest;
• your baby’s head is turned to one side and visible;
• your baby’s nose and mouth are not covered;
• your baby’s neck is straight not bent;
• your baby’s back is covered with a blanket;
• you are not wearing tight restrictive clothing or neck jewellery.
After the birth of your baby you are transferred back to the maternity ward where the
midwife will check your baby’s identification bands and confirm sex of your baby. You
will spend time in the ward getting to know your baby and preparing for when you
leave hospital to go home. The midwives, student midwives and care assistants on
the ward will guide, teach and help you to care for yourself and your baby.
Baby Tagging System

To make sure your baby is safe and secure, they must wear the security tag and
identification bands at all times while they are in the hospital. It is important to
remember that if you try to move your baby outside the ward area your baby’s security
tag will set off an alarm. If you notice that a band or the tag has come off please tell a
member of the ward staff immediately and they will re-secure it for you.
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Vitamin K
Vitamin K is a vitamin which occurs naturally in food. It helps to make our blood clot
properly in order to prevent excess bleeding. At birth, babies have very low stores of
this vitamin which is quickly used up over the first few days of life. Once feeding is
established the baby gradually builds up its own vitamin K stores.
What is vitamin K deficiency bleeding (VKDB)?

VKDB is caused by a deficiency of vitamin K and results in life threatening bleeding for
the baby. Giving Konakion prevents and treats bleeding caused by a lack of vitamin K.
When does VKDB occur?

VKDB can occur within 24hours (early onset), within the first week of birth (classical
onset), or from the first week and for up to six or eight months (late onset).
What is the risk of VKDB?

The risk of VKDB is very small. It occurs in approximately 1 in 10,000 babies. It is
recommended that all babies receive a vitamin K supplement as soon as possible
after birth to protect against vitamin K deficiency bleeding.
How will I know if my baby has Vitamin K deficiency bleeding (VKDB)?

A baby who develops this condition might have excessive bleeding from their
umbilical cord, nose, mouth, or have an unexpected bruises. Some babies may also
have jaundice (a yellow tinge to their skin). Any baby that is still jaundiced after two
weeks of age should be seen by a doctor and especially if they are not gaining weight
properly, have pale stools (poo) and dark urine, or ill in any way. The blood loss may
not always be visible; when it occurs in the brain it may cause brain damage or death.
Which babies are more likely to develop this condition?

While it is not possible to identify all babies who will develop VKDB, some babies are
thought to be more at risk, these include,
• Babies that are born early (premature)
• Babies born by forceps or ventouse (vacuum extraction) delivery where
bruising can occur.
• Babies born to mothers who were on certain medication e.g. antiepileptic
drugs, anticoagulants (blood thinners), anti tuberculosis drugs.
• Babies who feed poorly or find it hard to absorb feeds properly.
• Babies who have an underlying liver disease that may show as prolonged
jaundice
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Does Vitamin K have any side effects?

In 1990, a small study suggested a link between giving vitamin K by injection and later
childhood cancers. The accuracy of this study has been severely criticised.
Several studies, looking at thousands of children, have shown no evidence whatsoever
of any link between vitamin K injection and later childhood cancers.
Most babies do not get unwanted side effects from vitamin K. However, in very rare
cases, a skin reaction (a rash) may occur. Rarely, reactions at the site of injection may
occur which may be severe and may cause scarring.
Infants with coagulation disorders such as haemophilia may develop severe bruising
after IM injections and infants with a family history of these conditions should receive
oral vitamin K.
How is Vitamin K given?

There are two ways of giving Vitamin K to your baby;
• It can be given as a single injection into the muscle of the baby’s leg
(intramuscular route). A single dose is given at birth or soon after (usually
within 2 hours) by the midwife; it does not need to be repeated. Intramuscular
administration is recommended if your baby is born prematurely or has other
risk factors identified by your midwife and or doctor, as your baby is at greater
risk of VKDB.
• It can also be given by mouth (orally); however it may not be well absorbed and
will require repeated doses.
Additional Helpful Information

If you require any further additional information in order to make an informed choice
on vitamin K, please ask your midwife at your clinic visits,
or with your GP or with your midwife / paediatrician prior to your delivery
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The Midwife’s Check

The midwife caring for you will carry out a daily check on you and your baby.
They will want to know:
• How you are feeling and if you have any concerns
• If you are experiencing any difficulties with your baby
• If you are in pain
• How much you are bleeding vaginally (lochia)
• That you are passing urine without too much discomfort
The midwife will also check your breasts, your tummy and, if you have stitches your
perineum. She will ask you if you have pain especially in your legs and she may need
to check your haemoglobin (iron) level by taking a blood sample.
Anti-D
If your blood group is rhesus negative and if your baby’s blood group is rhesus positive
you will need an injection called Anti-D. We will give you this injection within 72 hours
of your baby being born.
Rubella (German measles) Vaccination

During your pregnancy we will have tested you to see if you are immune to rubella
(German measles). If you were not immune to rubella, we can give you the vaccine on
the day you are going home. Otherwise, you can get it from your own GP. Rubella is a
serious concern if a pregnant woman catches the infection during the first 20 weeks
of her pregnancy.
This is because the rubella virus can disrupt the development of the baby and cause a
wide range of health problems, such as:
• eye problems, such as cataracts (cloudy patches on the lens of the eye);
• deafness;
• heart abnormalities; and
• Brain damage.
The birth defects caused by the rubella virus are known as congenital rubella
syndrome (CRS).
If you get the vaccination, it is important not to become pregnant afterwards for one
month.
Further information is available on: www.immunisation.ie
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Blood Loss
After the birth of your baby you will lose blood from your vagina. This bleeding is
normal and is called ‘lochia’. The lochia can be heavy for a few days but will gradually
settle down, changing colour from red to brown and usually stops within four to six
weeks after the birth. The blood loss is caused by your womb contracting as it returns
to the way it was before you were pregnant.
Many women experience period like pain, often called ‘after pains’, in the first two-
three days following birth. You may notice these pains more when your baby cries
or you are breastfeeding. The midwife can give you pain relief when you need it. The
more children you have the more after birth pains you may have. If the bleeding gets
very heavy (for example, it soaks a sanitary pad in an hour or less) or if you notice any
clots or a bad smell from your lochia please tell the midwife looking after you. This
could be the start of an infection or a sign of ‘retained tissues’ which could require
treatment.
Breast changes
You will experience breast changes in the days after the birth of your baby whether
you are breastfeeding or not. This happens as nature prepares to fill your breasts
with milk. You will notice your breasts will become swollen, hard and sometimes
sore (engorged). However, this period is short because once you have established
breastfeeding your body will regulate the milk supply.
If you have decided not to breastfeed, you can help reduce the engorgement by
wearing a well-fitting bra with the straps pulled up firmly. It will also help if you
avoid stimulating your breasts so don’t let hot water fall directly on them while in the
shower. Breast engorgement will go if your baby does not stimulate the breasts by
sucking to produce milk. Talk to your midwife for advice.
Care of the perineum

Your perineum is the area between your vagina and back passage. If your baby was
born vaginally, you may have stitches that become tighter as the wound begins to
heal. This can make sitting down, walking and passing urine uncomfortable. Take
regular pain relief. Most over-the-counter painkillers are safe to take after birth at
home, but always check with your pharmacist, midwife or doctor. You could also try
sitting on a cushion to relieve the discomfort.
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Wash the perineal area frequently as this will keep the wound clean. Remember to
dry yourself well after washing. There is no need to add any disinfectant or salt to
the bath water as research has found bathing in plain water is much better for the
healing process. It is also important to change your sanitary towel frequently. Do not
use tampons as they can cause infection in the early days and weeks after you give
birth. Do not use plastic backed pads as they appear to increase the risk of infection.
Even if you did not need any stitches after the birth, you may still experience
discomfort and heaviness in your vaginal area. This is normal as you are likely to be
bruised and swollen around the vagina. Plenty of rest, warm baths,good hygiene and
pelvic floor exercises will all help to heal the area. If you have any concerns about pain
or discomfort, please tell your midwife.
Bowel Motions
Many women worry about opening their bowels for the first time after the birth as
they are scared that their stitches might burst. Rest assured that this will not happen.
Use a clean pad to support the perineum while the bowels open. To avoid becoming
constipated, drink plenty of water and eat high fibre food such as fruit and vegetables.
Gentle exercise will also benefit you.
Mobility
If you had an epidural during your labour and birth, you will need to stay in bed for at
least four to six hours after the birth. This allows the effects of the drugs used in the
epidural to wear off completely.
Do not try to get out of bed by yourself. Even if you think your legs feel normal you
may become weak when you stand up. You will be given a call bell so please call us for
assistance the first time you want to get out of bed.
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Deep Vein Thrombosis (DVT)

A DVT, can occur during the postnatal period. The most common time appears to be
3-4 weeks after the birth of a baby. This is more common if you have had a caesarean
section or were immobile during the pregnancy with any medical condition.
This is another reason why we encourage early mobility after delivery.
If you feel generally unwell, and have pains in your legs, please contact your GP for
Assessment. Chest pain and breathlessness may also be a symptom. Adequate
analgesia is important. You may be asked to wear TED (anti-embolitic) stockings, or
have to get small injections to prevent clots developing if you are at risk of developing
a DVT. Your midwife will help and advise you if required.
Cervical Screening
The cervical smear test is a screening test, which checks to see if the cells that make
up the surface of the cervix are normal. It aims to identify any abnormality which can
be simply and effectively treated and therefore prevent long-term problems. Regular
cervical screening helps to reduce your risk of developing cervical cancer. The benefits
of regular cervical screening outweigh the limitations. A screening programme like
Cervical Check could reduce the number of cases of cervical cancer by as much as
80% over time. Cervical Check will offer you a free screening test: every three years if
you are aged 25 to 44, and every five years if you are aged between 45 and 60.
If you are up to date with your smear test you will not need a special one after the
birth. If your smear test is due you should wait for 12 weeks after giving birth before
having a smear test. It is best to have a cervical screening test when you are not
having your period. Cervical screening is free in Ireland with ‘Cervical Check’. You
should register with your GP or Well Woman centre to avail of this service. For further
information, check the website www.cervicalcheck.ie Freephone 1800 45 45 55.
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Breast self-check
How to check your breasts
It is important that every woman is breast aware. This means knowing what is normal
for you so that if any unusual change occurs, you will recognise it. The sooner you
notice a change the better, because if cancer is found early, treatment is more likely
to be successful.
Breast changes to be aware of
• A change in size or shape
• Change in the nipple- in direction or shape, pulled in or flattened nipple
• Changes on or around the nipple- rash or crusted skin
• Changes in the skin-dimpling, puckering or redness
• Orange peel appearance of the skin caused by unusually enlarged pores
• Swelling in your armpit or around your collarbone
• A lump any size, or thickening in your breast
• Constant pain in one part of your breast or armpit
Pregnancy & Breastfeeding

The changes that occur during your menstrual cycle continue during pregnancy.
While breastfeeding, your breast may become very enlarged, firm and tender, this is
normal at this time. However you should continue to check your breasts and discuss
any unusual changes with your GP.
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Postnatal Exercise
Most of your body’s pregnancy changes
return to normal automatically over time
(your uterus will have reduced in size
by 6-8 weeks and your ligaments will
have tightened by 5 months after your
baby’s birth). During pregnancy your
fitness levels and muscle tone may have
decreased. Therefore it is important to
start exercising as soon as possible after
the birth of the baby. This will help restore your strength and give you a better fitness
level, helping to regain your figure, lose any extra weight and help with maintaining
continence.
You should do exercises that are easy and enjoyable for you and do not require extra
equipment. Take care as exercise may put strain on your back and abdomen as a result
of circulating hormones and low toned abdominal muscles. Remember to get plenty
of rest as tired muscles are at greater risk of injury and strain. After your pregnancy, it
is essential to regain your abdominal, pelvic floor and core strength which will help to
prevent pain and dysfunction in the lower abdomen and back areas. You can start low
impact exercises such as walking, cycling and swimming when you feel ready.
Swimming is discouraged until after your 6 week check to ensure any birth trauma
is fully healed. However you shouldn’t attempt high impact exercise until at least 3
months after the birth of your baby, no matter how fit you were before your pregnancy
or the type of delivery you had. If started too soon, it can place a great deal of stress
on the pelvic floor and potentially slow down your recovery. Classes such as Pilates
and yoga can be very beneficial in regaining strength and condition.
It is important to be aware of your posture particularly prolonged flexed postures

when feeding and changing the baby. You should also start your pelvic floor exercises
as soon as you can after the birth of your baby regardless of the way your baby was
delivered. These can be done on your side and lying on your back initially as these
are the easiest positions in the early days after delivery and as you start to feel better
you can do then sitting, standing or during normal daily activities. By your 6 week
check any symptoms of back pain, PPGP or incontinence should have resolved or be
significantly improved. If not make sure to mention to your doctor who can arrange a
referral to physiotherapy department at (090) 9648278.
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Sitting / Feeding your baby

When sitting, especially when feeding the baby avoid
slumping down into the chair.
Straighten your back and support it properly with pillows

if necessary.
Sit in a supportive chair with hips at 90°, avoiding low

couches and armchairs initially.
Use pillows under the baby to, this will allow you to sit
tall and take the strain off your upper back and shoulders.
Placing a pillow under your arm to support may also help.
Alternate sides you feed and wind the baby, particularly if you are bottle feeding.
Pushing the buggy/pram

The handles should be at waist height if possible.
Stand tall and gently draw in your lower tummy when
pushing the buggy.
This will help to ease the strain on your back.
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Family Planning
Contraception may be the last thing on your mind when
you’ve just had a baby, but it’s something you need to think THINK
your guide to contraception
about if you want to delay or avoid another pregnancy. Many
unplanned pregnancies happen in the first few months
after childbirth, so even if you’re not interested in sex at the
moment, it’s better to be prepared.
How soon can I have sex again?

thinkcontraception.ie
You can have sex as soon as you and your partner both
want to. Having a baby causes many physical and emotional CP093 Think 80x115_Nov2010.indd 1 08/12/2010 17:08:31
changes for both partners and it may take some time before you feel comfortable or
ready to have sex. Everyone is different, so don’t feel pressured or worry that you’re
not normal if you don’t feel ready to have sex. It can help to talk to your partner or a
healthcare professional such as a nurse, doctor or health visitor about any concerns
you have.
When will my periods start again?

The earliest your periods can return is five to six weeks after the birth if you’re not
breastfeeding. Breastfeeding usually delays the return of your periods. You’re more
likely to start having them once you breastfeed less often and feeds are shorter, but in
some women they may return earlier. You can become pregnant before your periods
return because ovulation (releasing an egg) occurs about two weeks before you get
your period.
How soon do I need to use contraception?

You need to start using contraception from three weeks (21 days) after the birth.
Don’t wait for your periods to return or until you have your postnatal check before
you use contraception as you could get pregnant again before then.
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When can I start to use contraception?

You don’t need to use any contraception in the first three weeks (21 days) after the
birth as it’s not possible to become pregnant in this time. These methods can be used
or started any time after the birth:
• Male or female condoms.
• Progestogen-only pill.
• Contraceptive injection. When using the injection within six weeks of giving birth
you may be more likely to have heavy and irregular bleeding.
• Natural family planning. It may be more difficult to identify the signs and
symptoms of fertility immediately after giving birth or when you’re breastfeeding.
From three weeks after the birth if you’re not breastfeeding and have no other medical
risks, you can use:
• the combined pill
• the contraceptive patch
• the contraceptive vaginal ring.
Will breastfeeding act as a contraceptive?

Breastfeeding is also known as lactation. It can help to delay when you start ovulating
(releasing an egg) and having periods after the birth. This is known as lactational
amenorrhoea (LAM) and it can be used as a contraceptive method. LAM can be up
to 98 per cent effective in preventing pregnancy for up to six months after the birth.
All of the following conditions must apply:
• You are fully, or nearly fully, breastfeeding. This means you’re only giving your
baby breast milk, or you’re infrequently giving other liquids in addition to your
breast milk.
• Your baby is less than six months old.
• You haven’t had you first period since the birth.
The risk of pregnancy increases if any of these conditions apply:
• you start breastfeeding less often
• there are long intervals between feeds – both day and night
• you stop night feeds
• you use supplement feeding
• Your periods return.
Once your baby is over six months old the risk of getting pregnant increases, so even
if you don’t have periods and are fully or nearly fully breastfeeding, you should use
another contraceptive method.
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Will contraception affect my breast milk?

If you’re using a hormonal method of contraception a small amount of hormone will
enter the milk, but no research has shown that this will harm your baby. It’s advised
that you wait until the baby is six weeks old before starting the combined pill, the
contraceptive vaginal ring or the contraceptive patch. These methods contain the
hormone estrogen which may affect your milk production starting. Using the IUD
doesn’t affect your milk, and copper from it doesn’t get into the milk.
Further information is available on: www.thinkcontraception.ie
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Care following Caesarean Section

If you have had a caesarean section, the staff on the ward will help you move in the
bed and go to the bathroom for the first time. The midwife will care for your wound
and offer you pain control medicine.
The sooner you are up and about the better you will recover. We will ask you to wear
graduated elasticated stockings while in hospital and encourage you to move about
as often as possible to prevent a blood clot developing in your leg. You may also need
a daily injection of a blood thinning medication while you are in hospital.
Initially, the incision wound may be painful especially when you cough. This is due to
internal pressure on the wound. Placing a hand firmly on the wound when you cough
will help reduce the pain. Keep the wound clean and dry; the midwife will remove
stitches or clips usually five to seven days after the operation, if required.
Pico’ Dressing may be used for tummy area following caesarean section – follow the
instructions given for use.
As a caesarean section is major abdominal surgery you should not lift anything or
drive for 6-8 weeks following the birth. You should also check with your car insurance
company about when you can start driving again.
Abdominal wound care

Do:
• Do keep your wound clean and dry
• Do have a daily shower or bath using unperfumed soap. However, do not use
soap directly on the wound. Wash your wound with water only and gently pat the
area dry with a clean towel.
• Do try to find time each day to lie down and loosen all clothing from the skin
around the wound. Fresh air will dry your wound and help it heal. This is especially
important during warmer weather and if you are overweight.
• If you need to touch your wound, wash your hands with soap and
• water before and after.
Do not:
• Do not touch your wound unnecessarily
• Do not place a dressing on your wound, unless advised by your midwife, PHN
or GP
96
• Do not use antiseptic creams, washes or sprays on the wound
• Do not use other products on the wound unless advised by your doctor. This
includes moisturiser, tea tree oil, honey, arnica and essential oils. When your
wound is fully healed which may take 2-6 weeks, these products are safe to use
then.
• Do not use swimming pools, saunas or hot tubs until your wound is completely
healed.
How will I know if my wound is infected?

• Fever greater than 38oC for 2 readings taken 4 hours apart
• Increased pain or swelling of the wound.
• Your wound oozes blood stained fluid, yellow fluid or becomes smelly.
• Redness spreads to the skin around the wound.
• Your wound appears to be opening.
If you have questions, concerns or urgent needs, call the hospital at (090-96248233)
or your GP.
Planning for a vaginal birth after caesarean

If you have had one or more caesarean deliveries, you may be thinking about how
to give birth next time. Whether you choose to have a vaginal birth or a caesarean
delivery in a future pregnancy, either choice is safe with different risks and benefits.
Overall, both are safe choices with only very small risks.
In considering your choices, your obstetrician will ask you about your medical history
and about your previous pregnancies. You and your obstetrician or midwife will
consider your chance of a successful vaginal birth, your personal wishes and future
fertility plans when making a decision about vaginal birth or caesarean section.
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What to expect emotionally

Having a baby changes every woman’s life dramatically. Many new mothers find
the early months of adjusting to parenthood a time of mixed emotions. Nothing can
prepare you for the feeling of responsibility of a new baby. Minor events can sometimes
cause a flood of tears or feelings of anxiety and helplessness. Not everyone falls in
love with their baby immediately. Do not feel guilty, take each day as it comes; with
time things will improve. If your concerns/anxieties interfere with the pleasure in your
life, get some help. Your feelings are not uncommon and not permanent.
The ‘baby blues’

In the first weeks after the birth of a baby, most women experience sudden changes in
their emotions. One minute you are on top of the world, the next upset or tearful for
no apparent reason. Some mothers feel very tense and anxious. Others feel generally
unwell and excessively tired. This is often called ‘baby blues’. It usually occurs during
the first week or so and lasts a short while. Up to four out of five women experience
the ‘baby blues’.
Postnatal Depression
Looking after your emotional or mental health is very
important when you become a parent. Talk to your
partner or family if you feel tearful or weepy. Some
mothers may experience a type of depression after they
have had a baby called postnatal depression. It usually
develops in the first four to six weeks after childbirth,
although in some cases it may not develop for several
months
Postnatal depression is a term used to describe feelings

of depression you may get after you have a baby. About
10-20% of women are affected by postnatal depression
in the first few months after giving birth. After the birth
you may:
• Have no interest in yourself or your baby
• Feel panic, anxiety, dizziness, a fast heartbeat, sick in your stomach or sweaty
• Cry
• Be afraid of being left alone with your baby
• Feel resentful towards your partner
98 • Feel tired but unable to sleep
• Have no appetite or you may over eat

• Find it hard to concentrate or
• Lose interest in sex
If you or your family notice some of these signs, then speak with your partner, a family
member, doctor or public health nurse. Remember, postnatal depression does not last
forever and the sooner it is recognised, the sooner you will get better. Get a copy of
this leaflet from the publications section of www.healthpromotion.ie
If you would like to find out more information about nearest local depression support
groups call 01-6617211 or email info@aware.ie
Perinatal Support Group

Aims is to help new and expectant mothers experiencing symptoms of
postnatal depression, anxiety and other perinatal mood disorders.
Venue: Unit 8, Merlin Park University Hospital,

Merlin Park, Dublin Road, Galway
(Directions: enter main gate, continue up avenue, follow signs, take 4th right
turn, go to end of road & turn left. Unit 8 is on the right. Parking is available
outside.)
Time: 1st Wednesday of every month at 7.30pm
• Free • No referral needed • No booking required
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Caring for your baby

Keeping your baby warm
Thermal protection of the newborn is a series of measures taken at birth and during
the first few days of life to ensure your baby does not become too cold or too hot
and maintains a normal temperature. The newborn infant regulates body temperature
much less efficiently than an adult and loses heat more easily. In general, newborn
babies ( especially smaller babies) need a much warmer environment than an adult.
In the days following birth, hypothermia can be avoided by: rooming in with your baby,
breastfeeding as long and as often as your baby wants, appropriate dressing of your
baby- dry vest, a babygro and hat (babies can lose as much as 25% of heat if they
don’t wear a hat) and at least two layers of a cellular blanket. Cardigan if required. The
number of layers of clothing necessary depends on the environmental temperature.
As a general rule newborns need one or two more layers of clothing and bedding than
adults (WHO, 1997-thermal protection of the newborn- a practical guide)
Feeding your baby

Breastfeeding is the normal way to nourish and nurture
your baby. Your breast milk is all your baby needs
for the first 6 months. Your breast milk continues to
provide an important part of your baby’s diet as he or
she grows. Breastfeeding is soothing and comforting
for your baby and creates a special closeness. The
Health Service Executive Ireland in line with the World
Health Organisation recommend that babies should be
exclusively breastfed for the first six months of life. You
should continue to breastfeed in combination with solid
foods until baby is 2 years old.
Good health begins with skin to skin contact and breastfeeding

Breastfeeding protects your health and your baby’s health. Is important for your
baby’s healthy growth and development. It provides antibodies to protect your baby
from illness and build your baby’s immune system
Research shows that children who are not breastfed have a greater risk of developing:
• Ear, nose and throat infections
• Stomach, kidney and chest infections
• Asthma and eczema
• Obesity (very overweight)
• Diabetes
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• Cot death
Breastfeeding will also help you to be a healthy weight and protect your health by
reducing your risk of: breast cancer, ovarian cancer and diabetes.
When do I feed my baby?

It is best to feed your baby when he or she shows ‘early feeding cues’. Early feeding
cues include:
• Your baby’s eyes moving over and back, even if his or her eyelids are closed
• Your baby opening and closing his or her mouth
• Your baby’s hands moving towards his or her face or mouth.
• Rooting’ turning his or her head side to side when you touch your baby’s cheek,
or trying to move
• Your baby making cooing noise
Feeding your baby often when he or she shows early feeding cues and letting your
baby feed as long as he or she wishes, helps to ensure that you have a good supply
of milk.
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Guidelines for mothers

Your baby’s 1 Week 2 3
age 1 Day 2 Days 3 Days 4 Days 5 Days 6 Days 7 Days Weeks Weeks
How often
At least 8-10
should you At least 10-12 feeds per day.
feeds per day.
breastfeed?
Per day, on average
over 24 hours. Your baby should be sucking strongly, slowly, steadily and swallowing often.
Your baby’s
tummy size
Size of a cherry. Size of a walnut. Size of an apricot. Size of an egg.
Nappies:
How many,
how wet?
Per day, on average At least At least At least At least 6 heavy wet with
over 24 hours. 1-2 wet. 3 wet. 5 wet. pale yellow or clear urine.
Dirty nappies:
Number and
colour of stools
Per day, on average At least 1 to 2 black At least 2 At least 2 large, soft
over 24 hours. or dark green. yellow. and seedy yellow.
Your baby’s Babies lose an average of 7% of their birth weight in the first 3 days after birth.
weight From day 4 onward your baby should start to gain weight. It can take 2 to 3
weeks to get back to their birth weight.
Other signs Your baby should have a strong cry, move actively and wake
easily. Your breasts feel softer and less full after breastfeeding.
Every Your breastmilk gives your baby all the nutrients

breastfeed they need for around the first six months of life.
makes a Your milk continues to be an important part of their
diet, as other foods are given, for up to two years
difference
of age and beyond.
For professional information and support visit www.breastfeeding.ie

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How do I know my baby is getting enough milk?

• Your baby should have at least 6 nappies day and yellow seedy nappies from
day 5. This is a sign that your baby is getting enough milk.
• When you are feeding your baby, hold your baby close to you and support your
baby’s body. Your baby should be able to reach your breast easily, without having
to twist his or her head.
• When your baby opens his or her mouth wide, he or she can latch on well. Some
babies feed more at certain times of the day, often in the evening. This is normal.
In the next few weeks your baby may develop a more regular pattern of feeding.
It can take a week or two to get to know your baby. As time goes on breastfeeding
gets more enjoyable and rewarding
How can I breastfeed outside the home?

Breastfeeding is really convenient when you are out and about with your baby. Your
breast milk is always available and always at the right temperature. When you are out
and about, you can breastfeed anywhere you and your baby want or need to. Since
feeding often looks like cuddling a baby most people don’t even notice it. Wearing a
top that lifts to let your baby feed will help you feed discreetly. Some Mums like to
drape a scarf over their shoulder.
Breastfeeding Supports available in Portiuncula

• Discuss with a midwife and or doctor at your antenatal clinic visits. Portiuncula
is a Baby Friendly Health Initiative accredited hospital. This means that staff are
educated to a standard to meet the ‘Ten steps to successful breastfeeding’ in line
with the national breastfeeding policy.
• Midwives and neonatal nurses will support you when your baby is born.
• Clinical Midwife Specialist lactation is also available for phone consultation or
face to face meeting. You can meet with her before you have your baby, this is
important if breastfeeding didn’t go well previously; and after you have your baby
you can meet with her before and after discharge. Contact (090) 9624619. She
is available Monday to Friday excluding holidays
• Public Health Nurse will arrange to call to your home when you are discharged
from hospital.
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Breastfeeding Support Groups in Ballinasloe

• Brackernagh Health Centre- 1st and 3rd ; Wednesday of each month, it is
facilitated by the Portiuncula Clinical Midwife Specialist Lactation. Drop in, no
appointment necessary.
• Library- second and fourth Wednesday of each month. Facilitated by Cuidiu.
Drop in. No appointment necessary.
Other Breastfeeding Support groups

Cuidiu- www.cuidiu.ie
La Leche League- www.lalecheleagueireland.com
Friends of breastfeeding- www.friendsofbreastfeeding.ie
Visit www.breastfeeding.ie for breastfeeding information and contacts for community
support groups in your county.
A useful site for anyone expecting more than one baby is www.multiplebirth.org
Formula Feedings
If you choose not to breastfeed your baby, your baby will
need infant formula milk. Your midwife will advise you on
how to choose a suitable first milk, the cost of using formula,
the safety of local water supply. Your midwife will give you
information while you are in hospital on what you need and
how to make up the formula. At home, your public health
nurse and practice nurse will give you information and show
you how to formula feed your baby.
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Vitamin D
Vitamin D is important because it helps our bodies
use calcium to build and maintain strong bones and
teeth. Children (and adults) in Ireland have low levels
of vitamin D which can lead to weak bones.
In severe cases low levels of vitamin D can cause

rickets in children. There has been an increase in the
number of cases of rickets in Ireland in recent years.
Your baby needs vitamin D because:

• Their skin is very sensitive to the sun and should
not be exposed to direct sunlight
• Their food may not have enough Vitamin D in it
• Between 0-12 months babies grow very quickly and have a greater need for
vitamin D to form strong bones.
• Babies with African, Afro-Caribbean, Middle-Eastern or Indian ethnic
backgrounds are at even higher risk of having low levels of vitamin D.
How to make sure your body gets enough vitamin D

To help your baby get enough vitamin D the Food Safety Authority of Ireland
recommends that you give your baby a vitamin D supplement that provides 5
micrograms (5ug), equivalent to 200 international units (i.u.) of Vitamin D3 every
day until they are at least 1 year old. This advice is especially important if you or your
baby is dark-skinned. This advice is based on the ‘Recommendations of for a National
Policy on Vitamin D supplementation for infants in Ireland’ published by the Food
Safety Authority of Ireland in 2007.
Recommendation for Vitamin D supplementation

Give your baby a Vitamin D supplement that provides 5 micrograms (5us), equivalent
to 200 international units (i.u.) of vitamin D3 every day until they are least 1 year old.
Vitamin D3 (cholecalciferol) is the recommended type of vitamin D supplement for
babies. Choose a product that contains vitamin D3 only. If you have any questions
about vitamin D supplementation ask your baby’s doctor, dietician, pharmacist or
www.healthpromotion.ie
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Safe Sleep
Remember to place your baby on his back to sleep. Take care to turn your
baby’s head to the side (alternating sides) to prevent the back of his head
flattening. Keep the cot free of soft objects and anything loose or fluffy. The ideal
room temperature is 18 ºC or 65 ºF
Create a smoke-free zone for your baby - do not smoke during pregnancy and don’t let
anyone smoke in your home, car or around your baby. The safest place for your baby
to sleep at night is in a cot in your room - bed-sharing can be dangerous. Place your
baby with their feet to the foot of the cot and keep their face and head uncovered, the
cot free of soft objects and anything loose or fluffy. Make sure the cot and mattress
are in good condition.
• Make sure baby does not get too hot when asleep. Avoid overheating by ensuring
that your baby’s head is not covered and by using cellular blankets. A folded
blanket counts as two layers. Do not use duvets, cot bumpers or fleece blankets
as these can cause your baby to overheated
• Breastfeed your baby, if possible.
• Giving your baby a soother (dummy) when they are being put down to
sleep may reduce the risk of cot death.
• Let your baby have some time on their tummy, when they are awake and while
you supervise.
106
• Do not use sitting devices for routine sleep in the home - examples include car
seats, swings, infant seats.
• Get medical advice early and quickly if your baby seems unwell. Remember - if
it’s an emergency, dial 999 or 112
Tummy time
Remember to place your baby on their back for sleep.
However when they are awake and alert

placing them on their tummy can really
help their development. Babies achieve
better head control and stronger muscles
in their shoulders arms and necks when
they commence tummy time from birth.
While they are on their tummies, babies
move from side to side which helps them
to learn to crawl and reach.
Tummy time also helps to improve hand-
eye co-ordination and babies develop
better balance and co-ordination
Being on their tummy also prevents pressure on the back of the head which causes
plagiocephaly.
You can start once your baby is born by placing the baby on your chest in a semi-
reclined position.
Hold the baby facing you. This is a great way to play with your baby as they have to lift
their head to see your face, whilst also strengthening.
Carrying your baby in a tummy down position along your forearm is another nice way
to bring tummy time into your day. A small rolled up towel under their chest can help
your baby to raise their head and shoulders.
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Screening tests for your baby

There are a number of tests that we will offer for your baby while you are in hospital.
We will explain them to you and ask for your consent to vaccinate and do the tests
before doing them.
Newborn Infant Oxygen Saturation Test

All infants born at Portiuncula University Hospital will have the oxygen levels in their
blood checked by pulse oximetry prior to their discharge home. The procedure will be
performed by your midwife and involves attaching a small plastic probe to your infant’s
foot. It takes about two minutes to perform and your baby will not feel anything. The
test helps detect some heart problems that may not otherwise be possible to detect
during your baby’s newborn examination.
Newborn Bloodspot Screening Test

In the first week after your baby is born, you will be offered a Newborn Bloodspot
Screening Test for your baby. It is often referred to as the ‘heel prick’ test. This test
helps identify babies who may have a rare but serious condition. In Ireland, all babies
are now screened for:
Phenylketonuria, Maple syrup urine disease, Homocystinuria, Galactosaemia, Cystic
fibrosis, Congenital Hypothyroidism
You can read more about these conditions on www.newbornscreening.ie, or ask your
midwife or PHN.
Why should I have my baby screened?

Most babies who are screened will not have any of these conditions. For the small
numbers of babies who do, the benefits of screening are enormous. Screening means
that babies who have a condition are treated early. Early treatment can improve their
health and prevent severe disability or even premature death.
Screening your baby for all these conditions is strongly recommended. If your baby
has any of the conditions, the long-term benefit of screening is much greater than the
small discomfort they feel when the blood sample is taken. However, you can choose
not to have your baby screened.
Why would my baby have one of these conditions?

Most of these conditions are inherited. An inherited condition means your baby
received the genes that cause the condition from their parents. This also means there
is a risk that other babies born to these parents may have the same condition.
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Where can I get more information?

You can get more information on Newborn Bloodspot Screening from your midwife or
PHN, or on www.newbornscreening.ie
Newborn Hearing Screening Programme

One to two babies in every 1,000 born in Ireland are born with a hearing loss in one or
both ears. Most babies born with a hearing loss are born into families with no history
of hearing loss so it is important to screen all babies as early as possible. The hearing
screen will usually be carried out while your baby is settled or sleeping at the mother’s
bedside. www.hse.ie
Early identification and early intervention has the best outcomes developmentally for
the baby.
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Immunisations
Immunisation is safe and very effective way to protect your baby against certain
diseases. These diseases can cause serious illness or even death. Immunisation works
by causing your baby’s immune system to produce antibodies to fight these diseases.
Routine vaccinations commence at 8 weeks and are given by your GP.
Please ask your PHN for more information.
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Going Home
Registering the Birth of your baby
Following the birth of your baby you will receive a birth notification form from the
maternity staff. Please give the completed form to midwives before leaving the
hospital. An official Notification of Birth is then completed by the hospital, based on
the information provided by you (the Parent(s) and sent to the Register of Births,
Deaths and marriages Office letting the Registrar know that a birth has occurred.
This is not enough, however to register the birth.
You will be required to attend at the registrar’s office to sign the register of births and
thus obtain your baby’s birth certificate. A birth may be registered in the office of any
Registrar of Births, Marriages and Deaths, regardless of where it took place. The staff
of the hospital where your child was born or your local health centre will be able to
tell you where you can register the birth. The birth should be registered not later than
3 months after the date of the birth. Please remember to bring photo identification,
for example a passport or driving licence, and your Personal Public Service Numbers
(PPS Number).
Public Health Nurse

We fax your details to the public health nurse to let her know of your discharge. She
will visit you at home within the first 48hrs. She is your contact in the community
and can be contacted at your local health centre if you have any problems or require
assistance.
Before you leave the hospital tell the midwife who is looking after you whether you are
going to your home address.
If you are staying elsewhere, give that address. This is important so that the public
health nurse/community midwife can continue your postnatal care for you and your
baby.
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Portiuncula University Hospital
Ballinasloe, Co. Galway, H53 T971
Phone: (090) 964 8200

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Maternity Information

Portiuncula University Hospital

Your Health in Pregnancy 15

Getting ready for birth 56

Labour and Birth 62

Pain relief in labour 69

Special Care Baby Unit (SCBU) 80

After the birth of your baby 82

Care following Caesarean Section 96

What to expect emotionally 98

Caring for your baby 100

Going home 111 3

Antenatal screening checks and tests

Blood Tests at Your First Antenatal Visit

• Targeted anti-D Prophylaxis

Non-Invasive Prenatal Testing (NIPT)

Sex Chromosome Conditions

Will the mother need to have other tests?

Who can have the test?

What happens if I decide to have NIPT?

Your baby’s movements in pregnancy

Why are my unborn baby’s movements important?

How many movements are enough?

What factors can affect me feeling my baby move?

What can cause my baby to move less?

What if I am unsure about my baby’s movements?

What should I do if I feel my baby’s movements are reduced or

Less than 24 weeks pregnant

Between 24 weeks and 28 weeks pregnant

Over 28 weeks pregnant

The scan is normally performed within 24 hours of being requested.

What should I do if I find my baby’s movements are reduced again?

Vaccines & Pregnancy

Whooping Cough Vaccine

Whooping cough causes long bouts of coughing and

Varicella Zoster Immune Globulin

Further information is available on www.immunisation.ie

Your health in Pregnancy

The following tips can help keep you and

How much should I eat?

Being overweight (Body Mass Index/BMI=25-29.9kg/m2) or obese (BMI= greater

Vitamins and Minerals

Folic acid (folate)

• you have had a previous pregnancy affected by spina bifida

Take care with some foods

What are high risk foods?

What foods are safe?

How can food be prepared safely?

Exercise and pregnancy

Benefits of pregnancy exercise

What Exercise is recommended during pregnancy?

What Exercise is NOT recommended during pregnancy?

What is the recommended duration and frequency of exercise?

Exercises for the Pelvic Floor and Stomach muscles

The pelvic floor is comprised of the muscles,

delivery. It can be weakened during pregnancy due to constipation, increased pressure

• Women who perform exercises antenatally have stronger muscles postnatally.

Pelvic Floor Exercises

For further advice and information about physical activity log on to

Watch driving position, posture when working at a desk.

Optimal Fetal Positioning

So what can I do?